瑞替普酶与瑞替普酶联合还原型谷胱甘肽治疗方案在急性 ST 段抬高型心肌梗死患者中的应用效果对比

摘要

Objective To explore the superiority of recombinant tissue plasminogen activato combined with reduced glutathione hormone in the clinical treatment of acute ST segment elevation myocardial infarction.Methods Seventy-six patients with acute ST segment ele-vation myocardial infarction treated in Handan Central Hospital from January 2012 to December 2013 were surveyed.They had been as-signed into rPA groups and rPA combined with GSH group according to their treatment regimen.And differences between groups were analyzed by t test.CK,CK-MB,cTnT and SOD levels in serum of patients were detected,and differences of data were analyzed by χ2 method.There were statistically differences if P was lower than 0.05.Results Compared with prior treatment,CK,CK-MB,sTnT and SOD levels were highly increased in rPA group and rPA combined with GSH group after treatment(P <0.05).CK,CK-MB and cTnT levels of rPA combined with GSH group were increased less than rPA group(P <0.05),but SOD levels (P <0.05)were increased more than rPA group after 24h treatment.Compared with rPA group,vascular recanalization rate(P <0.05)and LVEF(P <0.05)of rPA combined with GSH group were significantly increased,while LVESd (P <0.05)and LVEDd (P <0.05)were at lower levels than rPA group.Patients in rPA combined with GSH group had a low probability of recurrent myocardial infarction,post infarction angi-na pectoris and arrhythmia incident.Conclusions There is a great clinical application value of rPA combined with GSH in treatment of acute ST segment elevation myocardial infarction.The treatment regimen of rPA combined with GSH can reduce the probability of re-current myocardial infarction,post infarction angina pectoris and arrhythmia incident,and improve the prognosis of the STEMI patients.%目的：探究瑞替普酶（rPA）联合还原型谷胱甘肽（GSH）在治疗急性 ST 段抬高型心肌梗死的临床优势。方法分析2012年1月至2013年12月该院收治的急性 ST 段抬高型心肌梗死患者76例，患者自主选择溶栓治疗方案被分为 rPA 治疗组和 rPA 联合 GSH 治疗组，在组间差异采用 t 检验方法；检测患者血清中心肌酶（CK）、心肌酶同工酶（CK-MB）、肌钙蛋白 T（cT-nT）和超氧化物歧化酶（SOD）等指标，数据分析采用χ2检验；各因素采用例数或百分比表示，P ＜0．05具有统计学差异。结果与治疗前相比，rPA 组和 rPA 联合 GSH 组在治疗后24 h 患者血清中肌酶（CK）、心肌酶同工酶（CK-MB）、肌钙蛋白 T（cTnT）和超氧化物歧化酶（SOD）的水平均明显升高；与 rPA 组后24 h 的结果比较，rPA 联合 GSH 组 CK（P ＜0．05）、CK-MB（P ＜0．05）和 cTnT（P ＜0．05）的升高幅度小，SOD 水平升高的幅度大于 rPA 组（P ＜0．05）。与 rPA 组比较，rPA 联合 GSH 组明显升高了患者的血管再通率（P ＜0．05）和左室射血分数（P ＜0．05）；而 rPA 联合 GSH 组的左室收缩末期内径（P ＜0．05）和左室舒张末期内径（P ＜0．05）明显低于 rPA 组。与 rPA 组比较，rPA 联合 GSH 组患者出现再发心肌梗死（P ＜0．05）、梗死后心绞痛（P＜0．05）和心率失常（P ＜0．05）的发生率明显降低。结论瑞替普酶联合还原型谷胱甘肽对于治疗急性 ST 段抬高型心肌梗死具有很好的临床应用价值，可以减少患者治疗后不良心血管事件的发生率，改善患者预后。