尿激酶原治疗急性心肌梗死的临床疗效观察

发布时间：2018-04-13 23:21

本文选题：急性心肌梗死 + 溶栓治疗　；参考：《山东大学》2017年硕士论文

【摘要】：目的:本文旨在通过收集临床病例,对急性ST段抬高型心肌梗死的患者使用尿激酶原进行溶栓,分析和评价尿激酶原的临床疗效。方法:随机选取新泰市人民医院心内科急性ST段抬高型心肌梗死(AMI)患者100例,其中50例作为实验组,给予尿激酶原溶栓;50例作为对照组,给予尿激酶溶栓。分别观察两组不同时间段的血管再通率,心肌酶峰值、达峰时间,并发症,出血率以及住院期间的病死率。结果:1.两组患者在年龄、性别、危险因素(包括高血压、糖尿病、高血脂、吸烟、肥胖)、入院时的心脏功能、发病至溶栓开始时间等方面,差异无统计学意义(P0.05)。2.尿激酶原组患者30min、60min、90min、120min再通率分别为10.00%、52.00%、80.00%、84.00%。尿激酶组患者 30min、60min、90min、120min 再通率分别为8.00%、30.00%、60.00%、62.00%。尿激酶原组各个时间段的再通率均高于尿激酶组,两组比较差异有统计学意义(P均0.05)。3.尿激酶原组梗死相关动脉再通率为70.00%,尿激酶组梗死相关动脉再通率为58.00%,两组再通率比较差异有统计学意义(P0.05)。4.尿激酶原组LVEF平均值为(55.95±10.23)%,尿激酶组平均值为(51.25±11.77)%,尿激酶原组明显高于尿激酶组,两组比较,差异有统计学意义(P0.05)。5.尿激酶原组CKMB峰值为(133.00±178.00)U/L,达峰时间为(8.2±4.50)h、CTnI 峰值为(12.50±10.26)ng/mL,尿激酶组为 CKMB 峰值为(160.00±132.00)U/L,达峰时间为(11.5±15)h、CTnI 峰值为(16.66±10.30)ng/mL。与尿激酶组相比较,尿激酶原组CKMB达峰时间提前、CKMB峰值和CTnI峰值降低,差异均有统计学意义(P均0.05)。6.尿激酶原组与尿激酶组相比较,能明显降低室壁瘤、严重心律失常、心力衰竭、梗死后心绞痛、血管再闭塞的发生,两者比较,差异有统计学意义(P0.05),但在心包积液形成方面,两者比较差异无统计学意义(P0.05)。7.尿激酶组消化道出血的有4例,占8.00%,脑出血的有1例,占2.00%,牙龈出血的有2例,占4.00%,尿激酶原组消化道出血有1例,占2.00%,脑出血的为0例,牙龈出血的有1例,占2.00%。尿激酶原组总出血的发生率明显低于尿激酶组,两者比较差异有统计学意义(P0.05)。8.尿激酶组有2例患者住院期间死亡,占4.00%,尿激酶原组有1例患者住院期间死亡,占2.00%,两者比较差异无统计学意义(P0.05)。结论:1.尿激酶原溶栓治疗急性ST段抬高型心肌梗死,与尿激酶相比,再通率高,并发症发生率低,死亡率低。2.尿激酶原榕栓治疗急性ST段抬高型心肌梗死,与尿激酶相比,出血率低,相对比较安全。
[Abstract]:Objective: to analyze and evaluate the clinical efficacy of urokinase prothrombolytic therapy in patients with acute ST-segment elevation myocardial infarction by collecting clinical cases.Methods: 100 patients with acute St segment elevation myocardial infarction (AMI) in Department of Cardiology, Xintai people's Hospital, were randomly selected, 50 of them were treated as experimental group, 50 patients were given urokinase thrombolytic therapy as control group, and urokinase thrombolytic therapy was given to 50 patients.The vascular recanalization rate, peak myocardial enzyme peak, peak time, complications, bleeding rate and mortality during hospitalization were observed in the two groups.The result is 1: 1.There was no significant difference in age, sex, risk factors (including hypertension, diabetes, hyperlipidemia, smoking, obesity, heart function at admission, onset time from onset to thrombolysis) between the two groups.The recanalization rates of patients with urokinase were 10.00 and 52.00 in 30 min, 60 min and 90 min / 120 min, respectively.In the urokinase group, the recanalization rates of 60 min / 90 min / 120 min were respectively 8.00 and 30.000.000 / 62.00, respectively.The recanalization rate of urokinase in each time period was higher than that in urokinase group, and the difference between the two groups was statistically significant (P < 0.05).The recanalization rate of infarct-related artery in urokinase group was 70.00g, and that in urokinase group was 58.00.The difference between the two groups was statistically significant (P 0.05).The average LVEF of urokinase group was 55.95 卤10.23, and that of urokinase group was 51.25 卤11.770.The average value of urokinase group was significantly higher than that of urokinase group. The difference between the two groups was statistically significant (P 0.05).The peak value of CKMB in urokinase group was 133.00 卤178.00 U / L, the peak time of CKMB was 8.2 卤4.50 卤10.26 ng / mL, the peak value of CKMB in urokinase group was 160.00 卤132.00 渭 L / L, and the peak time of CKMB was 11.5 卤15hTnI = 16.66 卤10.30 ng / mL.Compared with urokinase group, the peak time of CKMB in urokinase group was lower than that of urokinase group, and the peak value of CK-MB and CTnI was lower than that of urokinase group (P < 0.05).Compared with urokinase group, urokinase group could significantly reduce the incidence of ventricular aneurysm, severe arrhythmia, heart failure, post-infarction angina pectoris, and vascular re-occlusion. The difference between the two groups was statistically significant (P 0.05), but in the formation of pericardial effusion, there was a significant difference in the formation of pericardial effusion.There was no significant difference between the two groups (P 0.05. 7).There were 4 cases of gastrointestinal hemorrhage in urokinase group (8.00%), 1 case (2.00%) of cerebral hemorrhage, 2 cases (4.00%) of gingival hemorrhage, 1 case (2.00%) of gastrointestinal hemorrhage of urokinase group, 0 case of intracerebral hemorrhage and 1 case (2.00%) of gingival hemorrhage.The incidence of total hemorrhage in urokinase group was significantly lower than that in urokinase group, and the difference between them was statistically significant (P 0.05. 8).In the urokinase group, 2 patients died during hospitalization (4.00%), and one patient died in the original group (2.00%). There was no significant difference between the two groups (P 0.05).Conclusion 1.Urokinase prothrombolytic therapy for acute ST-segment elevation myocardial infarction, compared with urokinase, compared with urokinase, the rate of recanalization is higher, the incidence of complications is low, and the mortality rate is lower than that of urokinase.Compared with urokinase, the rate of bleeding was lower and the treatment of ST-segment elevation myocardial infarction was safe.
【学位授予单位】：山东大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R542.22

【相似文献】