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目的:探讨急性心肌梗死发病不同时期、不同剂量尿激酶静脉溶栓治疗的疗效及安全性。方法:对173例采用尿激酶溶栓治疗的急性心肌梗死病人的临床资料作回顾性分析,比较发病不同时期、不同剂量尿激酶静脉溶栓治疗的疗效及安全性。结果:使用50万u、75～100万u、120～150万u尿激酶静脉溶栓治疗的再通率在起病3小时内组分别为64.3%、78.9%、77.8%(三者无显著性差异,P>0.05);在起病3～6小时组分别为16.7%、25.0%、70%(后者与前二者比较,差异有显著性,P<0.05);在起病>6～12小时组分别为0、11.1%、15,8%(三者无显著性差异,P>0.05)。使用50万u、75～100万u、120～150万u尿激酶静脉溶栓治疗病人的出血发生率分别为2.1%、10.4%、12.5%(前者较后两者低,P<0.05)。结论:急性心肌梗死起病3小时内,予尿激酶50万u可达到有效的溶栓目的,且可减少出血并发症。而起病3～6小时者,则宜予尿激酶120～150万u方可达到有效的溶栓目的。
Objective: To investigate the efficacy and safety of different doses of urokinase intravenous thrombolysis in different periods of onset of acute myocardial infarction. Methods: The clinical data of 173 patients with acute myocardial infarction treated with urokinase thrombolysis were retrospectively analyzed. The efficacy and safety of intravenous thrombolysis with different doses of urokinase at different stages of the disease were compared. Results: The recanalization rate of 50 000 u, 75 100 000 u, 1.2-1.5 million urokinase intravenous thrombolysis was 64.3%, 78.9% and 77.8% within 3 hours of onset respectively (P> 0.05). In the group of 3 to 6 hours of onset, the incidence was 16.7%, 25.0% and 70% respectively (the latter was significantly different from the former two groups, P <0.05) ~ 12 hours group were 0,11.1%, 15,8% (no significant difference between the three, P> 0.05). The bleeding rates of patients treated with 500,000 u, 75 to 1 million u, 120 to 1.5 million urokinase intravenous thrombolysis were 2.1%, 10.4% and 12.5% respectively (the former was lower than the latter, P <0.05). CONCLUSION: Within 3 hours after onset of acute myocardial infarction, 500,000 u of urokinase can reach the goal of effective thrombolysis and can reduce the bleeding complications. The onset of 3 to 6 hours, it is appropriate to give urokinase 120 ~ 1.5 million u can achieve effective thrombolysis purposes.