CAJ | 학술논문

目的：观察人重组组织型纤溶酶原激活剂（rt‐PA ）溶栓治疗急性心肌梗死患者的疗效以及安全性的研究。方法选取开封市中心医院急诊科及EICU于2012年8月至2014年1月42～75岁门诊及急诊收治诊断明确心肌梗死患者123例，根据治疗方案的不同分为A、B两组，分别给予内科保守基础上溶栓治疗及单纯内科保守治疗，观察两组患者的生命体征动态演变，同时在发病一周后，行经皮冠状动脉造影检查，观察冠状动脉病变的特点，比较两组患者从发病起4周内并发症的发生率、入院后两组患者治疗的死亡率。结果治疗后行冠脉造影检查，A组冠状动脉血管的再通率高于B组；A组患者并发症发生率均低于B组，四周内两组出现比较严重的心律失常、心肌再梗塞死、心功能不全等不良事件发生率分别为119．4％和267．9％；A组患者住院4周的死亡率低于B组，两组分别为104．5％和250．0％。结论急性心肌梗死患者，在发病6 h之内尽早应用rt‐PA溶栓治疗，较内科保守治疗有更高的优越性，可以及时挽救濒临死亡的心肌，降低恶性心律失常等并发症的发生。
목적：관찰인중조조직형섬용매원격활제（rt‐PA ）용전치료급성심기경사환자적료효이급안전성적연구。방법선취개봉시중심의원급진과급EICU우2012년8월지2014년1월42～75세문진급급진수치진단명학심기경사환자123례，근거치료방안적불동분위A、B량조，분별급여내과보수기출상용전치료급단순내과보수치료，관찰량조환자적생명체정동태연변，동시재발병일주후，행경피관상동맥조영검사，관찰관상동맥병변적특점，비교량조환자종발병기4주내병발증적발생솔、입원후량조환자치료적사망솔。결과치료후행관맥조영검사，A조관상동맥혈관적재통솔고우B조；A조환자병발증발생솔균저우B조，사주내량조출현비교엄중적심률실상、심기재경새사、심공능불전등불량사건발생솔분별위119．4％화267．9％；A조환자주원4주적사망솔저우B조，량조분별위104．5％화250．0％。결론급성심기경사환자，재발병6 h지내진조응용rt‐PA용전치료，교내과보수치료유경고적우월성，가이급시만구빈림사망적심기，강저악성심률실상등병발증적발생。
Objective To observe the efficacy and safety of recombinant human tissue type plasminogen activator ( rt‐PA)in the thrombolytic therapy for patients with acute myocardial infarction . Methods The subject for this project was 123 cases of patients with acute myocardial infarction who were hospitalized in the Department of Emergency and EICU of Kaifeng Central Hospital from Aug 2012 to Jan 2014 . They were diagnosed in outpatient and emergency with age range from 42 to 75 years old . They were divided into 2 groups based on protocol of treatment which were medicinal conservative treatment plus thrombolytic therapy ( group A ) and medicinal conservative treatment only ( group B ) respectively . The dynamic evolution of life signs of each group was recorded . Percutaneous transluminal coronary angiography was performed after one week of onset in order to investigate the feature of coronary artery pathogenesis and compare the rate of complication on the 4th week after onet , the prognosis and mortality after admission of two groups .Results The rate of coronary recanalization of group A was higher than that of group B under the coronary angiography after treatment . The rate of complication of group A was lower than that of group B . Severe adverse events such as arrhythmia , myocardial re infarction , cardiac dysfunction were occurred in 30 days in both groups , with a rate of 11 .94% and 26 .79% respectively . The mortality of group A (10 .45% ) was less than that of group B ( 25 .00% ) at 4 weeks after admission .Conclusion The thrombolytic therapy by rt‐PA should be applied as earlier as possible to patients with acute myocardial infarction within 6 hours after onset . This therapy was more advantageous than medicinal conservative treatment only which could save dying myocardium in time and decrease the incidence rate of complication like malignant arrhythmia . The patients in group A had better results of heart function recovery , index like Ejection fraction , ST‐T segment resolution , alleviation of chest pain than those of group B . At the same time , in the process of dynamic changes of myocardial enzyme , the peak value came earlier for group A than that for group B which provided evidence for successful thrombolytic therapy . The mortality of the patients with thrombolytic therapy declined significantly at 4 weeks after admission .