目的：比较瑞替普酶(rPA)与小分子肝素(依诺肝素)对急性ST段抬高型心肌梗死(STEMI)患者急诊静脉溶栓治疗的临床疗效。方法观察2008年11月~2010年10月间在本院急诊室内接受rPA或尿激酶溶栓并辅助普通肝素或依诺肝素抗凝治疗的72例STEMI患者,在血管再通率、心脏功能恢复程度、出血不良反应及预后等方面的差异。结果 C组(rPA+肝素)和D组(rPA+依诺肝素)溶栓再通率均明显高于A组(尿激酶+肝素)、B组(尿激酶+依诺肝素),且平均再通时间也明显缩短(P<0.05)。心脏彩超提示,治疗3个月后C、D组心脏功能的恢复更为明显。此外,B、D组轻度出血的发生率比A、C组降低(P<0.05)。结论 rPA辅助依诺肝素适合基层急诊室内进行STEMI的静脉溶栓治疗。%Objective To observe the clinical efficacy of intravenous thrombolytic therapy using reteplase (rPA) and anticoagulant treatment using low molecular weight heparin (Enoxaparin) in patients with ST segment elevation myocardial infarction (STEMI) in the emergency department of primary hospital. Methods Seventy-two patients with STEMI admitted in our department from November 2008 to October 2010 and received rPA or urokinase (UK) accompanying with heparin or Enoxaparin. The patency of infarct-related coronary artery assessed by unified clinical criteria or angiography, recovery of heart function analyzed by echocardiography, adverse events, various complications of myocardial infarction and mortality were observed. Results Group C (rPA+heparin) and group D (rPA+Enoxaparin) showed the higher rates of patency and faster recanalization time in infarct-related coronary artery than group A (UK+heparin) and group B (UK+Enoxaparin), respectively (P<0.05). The effect on recovery of heart function was greater in group C and D by rPA. Additionally, less events of hemorrhage occurred in group B and D (P<0.05). Conclusion Reteplase accompanying with Enoxaparin is an effective, reliable and safe thrombolytic therapy for the treatment of ST segment elevation myocardial infarction in the emergency department of primary hospital.
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