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摘 要 目的:总结心肌梗死急救经验,进一步提高临床疗效,降低病死率。方法:收治心肌梗死患者138例,随机分成对照组和观察组各76例,对照组进行常规方法治疗,观察组在对照组的基础上给予尿激酶治疗。结果:经过治疗观察组半小时胸痛缓解67例(88.2%),2小时ST段下降>50% 38例(50.0%),冠脉再通47例(61.8%),死亡5例,死亡率6.6%;对照组半小时胸痛缓解38例(50.0%),2小时ST段下降>50% 8例(10.5%),冠脉再通10例(13.2%),死亡12例,死亡率15.8%,两组比较差异有统计学意义(P<0.05)。结论:尿激酶溶栓治疗急性心肌梗死症状缓解快,血管再通率高死亡率低等,疗效显著。
关键词 心肌梗死 急救治疗 溶栓治疗
Abstract Objective:To summarize the experience of emergency treatment of myocardial infarction and to further enhance the clinical curative effect and to reduce the mortality rate.Methods:138 cases of myocardial infarction patients from 2012 July to 2013 July were randomly divided into the observation group and the control group with 76 cases in each.The control group was given routine treatment and the observation group was given routine treatment with urokinase therapy.After treatment in the observation group half hour chest pain remission is 67 cases(88.2%),two hours of ST decreased>50% is 38 cases(50%),coronary recanalization is 47 cases(61.8%),5 cases was death and the mortality rate was 6.6%.After treatment in the control group half hour chest pain remission is 38 cases(50.0%),two hours of ST decreased>50% is 8 cases(10.5%),coronary recanalization is 10 cases(13.2%),12 cases was death and the mortality rate was 15.8%.There were significant differences between two groups(P<0.05).Conclusion:Urokinase thrombolytic therapy has obvious therapeutic effect on acute myocardial infarction and it is worth spreading.
Key words Miocardial infarction;Emergency treatment;Thrombolytic therapy
资料与方法
2012年7月-2013年7月收治心肌梗死患者138例,梗死部位:前间壁24例,前侧壁35例,前壁28例,后壁16例,下壁35例。其中男88例(63.8%),女50例(36.2%),男女之比1.76:1,年龄44~68岁,平均54.6岁。其中典型心肌梗死114例(82.6%),不典型24例(17.4%),心功能分级:Ⅰ级66例(47.8%),Ⅱ级31例(22.6%),Ⅲ级22例(15.9%),Ⅳ级19例(13.7%)。随机分成对照组和观察组各76例,两组在年龄、性别、梗死部位、心功能分级等方面差异无统计学意义。
方法:对照组进行常规方法治疗,包括心电监护、吸氧、卧床休息、纠正水电解质紊乱和酸碱平衡失调,静脉滴注硝酸甘油抗栓,口服肠溶阿司匹林[1]。观察组在对照组的基础上150万U尿激酶加入100ml 0.9%氯化钠溶液中静脉滴注,腹部皮下注射低分子钙素5000U,2次/日,连用1周。
结 果
两组临床疗效比较:经过治疗观察组半小时胸痛缓解67例(88.2%),2小时ST段下降>50% 38例(50.0%),冠脉再通47例(61.8%),死亡5例,死亡率6.6%,对照组组半小时胸痛缓解38例(50.0%),2小时ST段下降>50% 8例(10.5%),冠脉再通10例(13.2%),死亡12例。死亡率15.8%,两组比较差异有统计学意义(P<0.05),见表1。
讨 论
急性心肌梗死治疗的关键是疏通血管,尽快恢复心肌血流再灌注,从而挽救濒死的心肌,保护心脏功能,降低病死率[2],常用的治疗方法包括冠心病介入治疗,其次就是溶栓治疗。
本文治疗组加用尿激酶溶栓明显提高了对急性心肌梗死的治疗效果,血管再通率高于对照组。尿激酶是一种丝氨酸蛋白酶,它可以直接激活纤维蛋白酶,促进纤维蛋白酶原转化为纤溶酶,从而可以水解已形成的纤维蛋白,达到溶解血栓的目的。
本组资料结果显示:两组经过治疗观察组半小时胸痛缓解67例(88.2%),2小时ST段下降>50% 38例(50.0%),冠脉再通47例(61.8%),死亡5例,死亡率6.6%;对照组半小时胸痛缓解38例(50.0%),2小时ST段下降>50% 8例(10.5%),冠脉再通10例(13.2%),死亡12例,死亡率15.8%,两组比较差异有统计学意义(P<0.05)。由此可见,尿激酶溶栓治疗急性心肌梗死症状缓解快,血管再通率高死亡率低等,疗效显著,值得推广。
参考文献
1 Meier MA,AIbadr WH,Cooper JV,et al.The new detinition of myocardial infartion:diagnostic and proghostic implications in patients with acute coronary syndromes[J].Arch Intern Med,2012,162(14):1585-1589.
2 Robbert J,et al.Value of Myoglobin,Troponin T,and CK-MB mass on Ruling out an Acute Myocardial.Infaraction in the Emergency Room[J].Circulatln,2005,92:3401-3407.
关键词 心肌梗死 急救治疗 溶栓治疗
Abstract Objective:To summarize the experience of emergency treatment of myocardial infarction and to further enhance the clinical curative effect and to reduce the mortality rate.Methods:138 cases of myocardial infarction patients from 2012 July to 2013 July were randomly divided into the observation group and the control group with 76 cases in each.The control group was given routine treatment and the observation group was given routine treatment with urokinase therapy.After treatment in the observation group half hour chest pain remission is 67 cases(88.2%),two hours of ST decreased>50% is 38 cases(50%),coronary recanalization is 47 cases(61.8%),5 cases was death and the mortality rate was 6.6%.After treatment in the control group half hour chest pain remission is 38 cases(50.0%),two hours of ST decreased>50% is 8 cases(10.5%),coronary recanalization is 10 cases(13.2%),12 cases was death and the mortality rate was 15.8%.There were significant differences between two groups(P<0.05).Conclusion:Urokinase thrombolytic therapy has obvious therapeutic effect on acute myocardial infarction and it is worth spreading.
Key words Miocardial infarction;Emergency treatment;Thrombolytic therapy
资料与方法
2012年7月-2013年7月收治心肌梗死患者138例,梗死部位:前间壁24例,前侧壁35例,前壁28例,后壁16例,下壁35例。其中男88例(63.8%),女50例(36.2%),男女之比1.76:1,年龄44~68岁,平均54.6岁。其中典型心肌梗死114例(82.6%),不典型24例(17.4%),心功能分级:Ⅰ级66例(47.8%),Ⅱ级31例(22.6%),Ⅲ级22例(15.9%),Ⅳ级19例(13.7%)。随机分成对照组和观察组各76例,两组在年龄、性别、梗死部位、心功能分级等方面差异无统计学意义。
方法:对照组进行常规方法治疗,包括心电监护、吸氧、卧床休息、纠正水电解质紊乱和酸碱平衡失调,静脉滴注硝酸甘油抗栓,口服肠溶阿司匹林[1]。观察组在对照组的基础上150万U尿激酶加入100ml 0.9%氯化钠溶液中静脉滴注,腹部皮下注射低分子钙素5000U,2次/日,连用1周。
结 果
两组临床疗效比较:经过治疗观察组半小时胸痛缓解67例(88.2%),2小时ST段下降>50% 38例(50.0%),冠脉再通47例(61.8%),死亡5例,死亡率6.6%,对照组组半小时胸痛缓解38例(50.0%),2小时ST段下降>50% 8例(10.5%),冠脉再通10例(13.2%),死亡12例。死亡率15.8%,两组比较差异有统计学意义(P<0.05),见表1。
讨 论
急性心肌梗死治疗的关键是疏通血管,尽快恢复心肌血流再灌注,从而挽救濒死的心肌,保护心脏功能,降低病死率[2],常用的治疗方法包括冠心病介入治疗,其次就是溶栓治疗。
本文治疗组加用尿激酶溶栓明显提高了对急性心肌梗死的治疗效果,血管再通率高于对照组。尿激酶是一种丝氨酸蛋白酶,它可以直接激活纤维蛋白酶,促进纤维蛋白酶原转化为纤溶酶,从而可以水解已形成的纤维蛋白,达到溶解血栓的目的。
本组资料结果显示:两组经过治疗观察组半小时胸痛缓解67例(88.2%),2小时ST段下降>50% 38例(50.0%),冠脉再通47例(61.8%),死亡5例,死亡率6.6%;对照组半小时胸痛缓解38例(50.0%),2小时ST段下降>50% 8例(10.5%),冠脉再通10例(13.2%),死亡12例,死亡率15.8%,两组比较差异有统计学意义(P<0.05)。由此可见,尿激酶溶栓治疗急性心肌梗死症状缓解快,血管再通率高死亡率低等,疗效显著,值得推广。
参考文献
1 Meier MA,AIbadr WH,Cooper JV,et al.The new detinition of myocardial infartion:diagnostic and proghostic implications in patients with acute coronary syndromes[J].Arch Intern Med,2012,162(14):1585-1589.
2 Robbert J,et al.Value of Myoglobin,Troponin T,and CK-MB mass on Ruling out an Acute Myocardial.Infaraction in the Emergency Room[J].Circulatln,2005,92:3401-3407.