急性心肌梗死早期静脉溶栓治疗临床价值.docVIP

急性心肌梗死早期静脉溶栓治疗临床价值 　　【摘要】 目的 探讨尿激酶早期静脉溶栓治疗急性心肌梗死(AMI)的临床价值。方法 回顾性分析21例AMI静脉溶栓病例，根据急性心肌梗死溶栓疗法参考方案[1]制订的再通标准计算梗死相关血管(IRA)的再通率及观察溶栓并发症、病死率。结果 本组静脉溶栓再通率为80．9%，合并轻度消化道出血3例。住院期间5周病死率为9．5%，死亡2例均并发心源性休克且为溶栓未通的大面积心肌梗死重症患者。有6例年龄75岁(最大者87岁)的患者溶栓再通，且无出血反应，取得了满意的疗效。结论 尿激酶早期静脉溶栓治疗AMI再通率高、不良反应小、疗效可靠，且操作简便、适合基层医院推广使用。? 　　【关键词】急性心肌梗死；尿激酶； 溶栓治疗；冠脉再通 　　? 　　The clinic value of forepart thrombolytic therapy via vein in the patients with acute myocardial infarction 　　 　　YANG Jian.CardiologyDepartment of,Nanping First Hospital，Nanping 353000，China 　　? 　　【Abstract】 Objective To discuss the clinic value of forepart thrombolytic therapy with drugs(urokinase)via vein in the patients with acute myocardial infarction(AMI).Methods 21 cases with AMI from October 2005 to February 2007 were analyzed retrospectively,recanalization rate and fatality rate of infarction relation artery were counted according as clinical recanalization indexe of thrombolytic therapy,simultaneity complications were observed.Results The recanalization rate was 80．9%and the fatality rate was 9．5%,3 cases combined gently alimentary canal bleeding in all,2 cases of death equal combined cardiac shock just were large acreage infarction with failed recanalization.6 cases of elderly patients(75 years old，the eldest patient was 87 years old)also acquired satisfying curative effect of recanalization,without alimentary canal bleeding.Conclusion Thrombolytic therapy with drugs(urokinase)via vein in AMI is an important treatment with high recanalization rate,less side-effect，credible curative effect even convenient operation,which adapts to spreading in grass-roots hospital.? 　　【Key words】Acute myocardial infarction；Urokinase；Thrombolytic therapy;Coronary recanalization 　　? 　　急性心肌梗死(AMI)静脉溶栓治疗已成为早期开放梗死相关血管(IRA),实施心肌再灌注的重要措施。IRA再通可缩小心肌坏??范围，改善心功能，减少左室重构，保护心功能。笔者回顾性分析南平市第一医院2005年10月至2007年2月应用尿激酶早期静脉溶栓治疗急性心肌梗死21例,探讨其临床应用价值。? 　　1 资料与方法? 　　1．1 一般资料 按照中华心血管病杂志编委会制订的《急性心肌梗死诊断和治疗指南》溶栓治疗适应证[2]，选择静脉溶栓病例21例，其中男18例，女3例，年龄38~87岁，平均6