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溶栓疗法在初发急性心肌梗死中的应用(PDF)

《心脏杂志》[ISSN:1009-7236/CN:61-1268/R]

期数:
2001年第1期
页码:
27-29
栏目:
论著
出版日期:
2001-01-25

文章信息/Info

Title:
Use of thrombolytic therapy for first acute myocardial infarction
作者:
李成祥; 王 爽; 宁亚兰; 李伟杰; 张玉顺; 王海昌; 张 清; 栾荣华; 张殿新; 郭文怡．贾国良
第四军医大学西京医院心内科，陕西西安71003
Author(s):
LI Cheng-xiang; WANG Shuang; NING Ya-lan; LI We&fie; ZHANG Yu—shun; WANG Hal-chang; ZHANG Qing; LU AN Roag-hua; ZH ANG Dian-xin; GUO W en-yi; JIA Guo-liang
Department of Cardiology．Xijing Hospital，Fourth Military Medical University，Xi an Shaanxi 710032，China
关键词:
心肌梗塞; 急性; 溶血栓疗法
Keywords:
myocardial infarction; acute; thrombolytic therapy
分类号:
R542.2
DOI:
-
文献标识码:
A
摘要:
目的 调查初发急性心肌梗死(AMI)溶栓疗法的应用现状及近期疗效。方法 总结我院1996-01~1999-08期间所有确诊初发AMI患者的临床资料，发病超过24 h入院、外院转来、心内膜下心梗、再梗患者除外．结果 202例初发AMI患者中，148例(73．3％ )符合溶栓适应证，132倒(65．3％)应用溶栓疗法．36例(24．3 ％)未蒋栓(16倒)或溶栓药物剂量不足(20例)。70倒未溶栓患者中，发病一入院>12 h、符合适应证而未予蒋栓、溶栓禁忌、入院心电图不能确诊AMI的比例分别为60.0％，22.8％，8.6％和8.6％。溶栓组住院期间病死率显著低于未溶栓组(6．1％ 15．7 ％，P<0．05)，其中再通组病死率显著低于未通组(2.3％w 20．8％， P<0.01)．结论 尽管蒋栓疗法改善了AMI的近期预后，但合理应用溶栓疗法的比例仍有待提高．患者入院过迟、溶栓治疗不积极是溶栓疗法应用偏低的主要原因。
Abstract:
AIM To survey the use of thrombolytic therapy(TT)for first acute myocardial infaretion (AMI)in recent years．METHODS Data from pauents with confirmed first AMI were co11ected in a single center during 1996 through 1999.The exclusion criteria include：the interval from symptom onset to presentation >24 h，transferred from other hospitals，subendocardia1 MI，and reinfarction．RESULTS Among 202 patients enrolled，1 32(65．3％)of 148(73．3％)padents eligible for TT received TT ，36(24．3 ％)received insufficient dosage of thrombolytic agents (2O)or even no TT (16)．Among 70 untreated patients，the elapsed time from symptom onset to presentation> 12 h，eligible but withholding from TT，contraindications，undiagnostic ECG were found in 22．8％，60.0％，8．6 ％and 8.6％ ，respectively．The inhospital mortality of patients treated with TT was significantly lower than in counterpart patients (6．1％vs15.7 ％，P< 0.05)．Of patients treated with TT，the mortality in the repeHusion subgroup was lower than in the counterpart subgroup(2．3％ vs 20．8 ％，P< O.O1)．CONCLUSION Although TT improvethe short·term prognosis for first AM I，it was still underused in recent years．The late arrival of the patients and unaggressive attitude of attending physicians toward TT mainly explainthis status．

参考文献/References

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[6]中华心血管病杂志编委会．急性心肌梗塞溶栓疗法参考方案[J] 中华心血管病杂志，1991，19(2)：137．

[7]Finbinolytie Therapy Trialists (FTT)Collaborative Group．1ndicationsh fibfinolytie therapy in suspected acute myocardial itvfaretion collaborative ovesclew of mortality and major morbidlty results from randomized tdals of m than 1000 patients[J]．Lancet，l994，343,311.

[8] Wilcox RG，for the LATE Steering Committee Late asessment of thrornbolytic efficacy with alteplase 6-24 hours after onset of acute myocardial infarction[J]．Lancet,1993，342:l75.

[9]Cibson CM，Cannon CP，Greene RM,et al．Rescue angioplasty in the Thrombolysis in Myocard1al Infarction(TIMI)4 Trial[J]．Am J Carciol，1997，80(1):21．

备注/Memo

备注/Memo:
收稿日期：2000-03-09.
更新日期/Last Update: 2001-01-25