急性心肌梗死溶栓治疗进展讲义.pptVIP

从疗效上比较，相对于瑞替普酶单次给药15MU、10MU+5MU两次静推来说，10 MU+ 10 MU两次静脉推注是最佳的给药方式；而且这种给药方式90分钟和60分钟再通率明显高于t-PA100毫克标准疗法，在RAPID-1的基础上，后来又有了RAPID-2试验。我们一起来看一下10MU(18mg)三十分钟重复该剂量，粉针剂加5至10ml生理盐水2-3分钟推注 * * RAPID-2试验是直接使用瑞替普酶10MU+10MU两次静推给药与阿替普酶90分钟加速给药法进行比较。 结果显示不论是60min还是90min开通率，TIMI2级还是TIMI3级开通率（注意使用激光笔），瑞替普酶的开通率都较阿替普酶高，尤其是60分钟开通率为82%，阿替普酶仅为66%，差别尤为显著，说明瑞替普酶能更快开通血管。 * * INJECT: Mortality Rates, Reteplase vs Streptokinase In the INJECT trial, more than 6,000 patients were randomized to receive Reteplase or Streptokinase within 12 hours of the onset of symptoms; approximately 80% of patients were treated within 6 hours.1,2 Patients treated with Reteplase had mortality rates at 35 days and 6 months that were not significantly different from rates with Streptokinase.1 Statistically significant reductions in the incidence of certain important clinical morbidity outcomes were shown for: Congestive heart failure LV function Hypotension Shock Atrial fibrillation Additional findings were as follows: Thrombolytic therapy increases the absolute risk of all strokes, including hemorrhagic strokes. Stroke rates were comparable in both groups. However, the rate of intracranial hemorrhage in the group treated with Streptokinase (0.37%) was significantly lower than the group given Reteplase (0.77%), P=.04).1 Like all thrombolytic agents, Reteplase increases the risk of bleeding, including cerebral bleeding. Reteplase should be used only in appropriate patients.3 Reteplase was shown to be effective in reducing mortality in AMI patients.1 1. International Joint Efficacy Comparison of Thrombolytics. Randomized, double-blind comparison of reteplase double-bolus administration with streptokinase in acute myocardial infarction (INJECT): trial to investigate equivalence. Lancet. 1995;346:329-336. 2. Data on file, Centocor, Inc. 3. RETAVASE? (reteplase) Prescribing Information. 这是瑞通立的II期临床研究，主要考查瑞通立的安全性和有效性。本试验是由北京大学人民医院胡大一教授牵头的多中心、随机、单盲、对照、平行的临床研究 。共有包括北京大学人民医院、北京大学第一医院、天津医科大学总医院在内的12家知名医院参与。试验分为两