HTUPA溶栓治疗急性ST段抬高心肌梗死的临床疗效

摘要

目的 评价人组织尿激酶型纤溶酶原激活剂(HTUPA)静脉溶栓治疗急性ST段抬高心肌梗死(STEMI)的临床疗效与安全性.方法 选择符合诊断标准的急性STEMI患者40例,随机分为HTUPA组与重组人组织型纤溶酶原激活剂(rt-PA)组进行溶栓治疗(每组20例).药物溶栓后监测实验室指标并行冠状动脉造影和心脏彩超检查,观察两种药物溶栓治疗后的梗死相关血管的再通率、心功能变化及不良事件,评价HTUPA疗效及安全性.结果 HTUPA组与rt-PA组的一般临床资料比较差异无统计学意义(P>0.05);rt-PA组与HTUPA组经冠状动脉造影证实的梗死相关血管再通率分别为80.0%和85.0%;两组出血率分别为35.0%和25.0%,两组在改善心功能方面差异无统计学意义(P>0.05).两组均有轻度出血发生,无严重不良并发症发生,rt-PA组有1例消化道出血.两种溶栓药物对肾功能、血清离子等没有造成不良影响.结论 ①HTUPA静脉溶栓治疗急性STEMI与rt-PA比较具有同等效果的梗死相关血管再通率.②HTUPA静脉溶栓治疗急性STEMI与rt-PA比较不增加出血事件,两种溶栓药物对心功能改善效果一样.③HTUPA用法简便,优于rt-PA,不需要持续静脉给药.%Objective To evaluate the efficacy and safely of Human lissue urokinase plasminogen activior ( HTUPA) for thrombolysis therapy of acute ST - segmenl elevaled myocardial infarclion( STEMI) by comparison with Recombinanl Lissue - Lype Lissue plasminogen acLivaLor(rL -PA). Methods Forty paLienLs who meet Lhe experimenLal criLeria and were randomly divided inLo Lhe HTUPA group (20 cases) and Lhe rt - PA group ( 20 cases). After Lhrombolysis Lherapy, To evaluaLe Lhe efficacy and safeLy of HTUPA for Lhrombolysis Lherapy of acuLe ST - segmenL elevaLion myocardial infarcLion (STEMI) , we can invesLigaLe Lhe laboraLory parameLers, adverse evenLs, coronary angiography ( CAG) and echocardiography Lo obLain Lhe infarcLion relaLed arLery (IRA) palency raLe and Lhe changes of heart function. Results There were no significant difference of general clinical feature (age, sex, weight, diabetes, hypertension, etc) between the two groups; it was proved that the reperfusion rate of HTUPA group was 85. 0% , rt - PA group was 80. 0% by coronary angiography ( CAG) , showing no obvious difference. Both of the two groups showed mild bleeding and had no serious adverse complications, rt - PA group had a case of gastrointestinal bleeding, The bleeding rate of HTUPA group was 25. 0% , the rt - PA group was 35. 0% . Statistical analysis shows the two groups have no significant difference to improve the cardiac function. There were no adverse effects of the two thrombolytic drugs on　the aspect of kidney funclion and serum ions. Conclusion (T)HTUPA is proved Lo be as effective as rt - PA for ASTEMI in the infarclion relaled artery patency rale. (2)HTUPA for thrombolysis therapy of ASTEMI by comparison with recombinanl Lissue - Lype lissue plasminogen aclivalor dose not increase the bleeding evenls, and has no difference in improvement of cardiac funclion. (5)HTUPA is a ihrombolylic medicine which is used easily and doesn't need continuous infusion.