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目的研究注射用瑞替普酶联合还原型谷胱甘肽治疗急性ST段抬高型心肌梗死的效果及安全性。方法选取2015年2月—2016年2月于湖北监利县人民医院接受治疗的急性ST段抬高型心肌梗死患者90例,按照不同的治疗方式分为A、B、C组,A组患者给予常规治疗,B组患者在常规治疗的基础上给予还原型谷胱甘肽治疗,C组患者在常规治疗的基础上给予注射用瑞替普酶联合还原型谷胱甘肽治疗,比较3组患者的血管再通率;疗效相关指标,包括肌酸激酶同工酶(CKMB)、肌钙蛋白I(c Tn I)、左心室舒张末期内径(LVEDd)及左室射血分数(LVEF);氧化应激相关酶,包括超氧物歧化酶(SOD)和谷胱甘肽过氧物酶(GSH-Px);不良反应,包括出血、再梗死、心绞痛、心律失常等。结果 C组患者首次治疗后2、6、12 h血管再通率较A、B组显著提高(P<0.05);与治疗前比较,3组患者治疗后疗效相关指标均得到明显改善(P<0.05);治疗后组间比较,C组各项指标改善均优于A、B组,差异显著(P<0.05)。B、C组患者治疗后,SOD及GSH-Px均较治疗前显著升高(P<0.05),B、C组间无明显差异。C组不良反应发生情况明显少于A、B组,差异显著(P<0.05)。结论注射用瑞替普酶联合还原型谷胱甘肽治疗急性ST段抬高型心肌梗死能有效改善心功能,提高血管再通率,抑制氧化应激反应,减少不良反应发生,临床上值得推广。
Objective To study the efficacy and safety of intravenous reteplase plus reduced glutathione in the treatment of acute ST-segment elevation myocardial infarction. Methods 90 patients with acute ST-segment elevation myocardial infarction who were treated in Jianli County People’s Hospital of Hubei Province from February 2015 to February 2016 were divided into A, B and C groups according to different treatment methods. Patients in A group were given Routine treatment, patients in group B were treated with reduced glutathione on the basis of routine treatment, and patients in group C were treated with reteplase plus reduced glutathione on the basis of conventional treatment. Patients in the three groups were compared Of the vascular recanalization rate; efficacy-related indicators, including CKMB, cTn I, LVEDd and LVEF; Stress related enzymes, including superoxide dismutase (SOD) and glutathione peroxidase (GSH-Px); adverse reactions, including bleeding, reinfarction, angina, arrhythmia and so on. Results The blood recanalization rates of the patients in group C at 2, 6 and 12 h after treatment were significantly higher than those in groups A and B (P <0.05). Compared with those before treatment, the indexes of therapeutic effect in all three groups were significantly improved after treatment (P < 0.05). After treatment, the improvement of each index in group C was better than that of group A and B (P <0.05). After treatment, the SOD and GSH-Px in group B and C were significantly higher than those before treatment (P <0.05), but there was no significant difference between group B and C. Adverse reactions in group C were significantly less than those in groups A and B (P <0.05). Conclusion Intravenous injection of reteplase combined with reduced glutathione in the treatment of acute ST-elevation myocardial infarction can effectively improve cardiac function, improve recanalization rate, inhibit oxidative stress and reduce the incidence of adverse reactions, which is clinically worth promoting .