摘要
目的评价半量注射用重组人TNK(rhTNK)组织纤溶酶原激活剂(rhTNK-tPA)溶栓治疗对老年急性ST段抬高型心肌梗死(STEMI)患者心肌再灌注的疗效及安全性.方法选取行溶栓治疗的老年STEMI患者(≥60且<75岁)80例,随机分为观察组42例及对照组38例,观察组在溶栓时间窗内给予半量8 mg rhTNK-tPA,对照组采用常规量16 mg rhTNK-tPA治疗.比较两组患者溶栓后临床疗效、出血事件以及严重不良事件发生情况.结果观察组梗死相关动脉的TIMI血流2~3级比率、TIMI血流3级比率、2 h心电图ST段回落>50%比率与对照组差异无统计学意义[TIMI血流2~3级比率:18例(81.81%)与17例(85%),P=0.487;TIMI血流3级比率:14例(63.63%)与13例(65%),P=0.552;心电图ST段回落>50%:16例(80%)与15例(83.3%),P=0.527];溶栓后1个月内,严重不良事件发生率两组间差异无统计学意义(P>0.05);颅内出血事件两组间差异无统计学意义[1例(2.38%)与1例(2.63%),P=0.972];消化道出血事件观察组低于对照组[消化道出血:3例(7.14%)与7例(18.42%),P=0.032];观察组溶栓后小/微出血事件(皮下出血、牙龈出血、穿刺部位血肿、泌尿道出血)低于对照组[皮下出血:3例(7.14%)与6例(15.78%),P=0.041;牙龈出血:2例(4.76%)与6例(15.78%),P=0.039;穿刺部位血肿1例(2.38%)与4例(10.52%),P=0.031;泌尿道出血:4例(9.52%)与8例(21.05%),P=0.028].结论对老年急性ST段抬高型心肌梗死患者进行半量注射用rhTNK组织纤溶酶原激活剂溶栓治疗,溶栓疗效相同,安全性优于全量,可能是临床上一个针对高龄STEMI患者合适的选择;可改善老年STEMI患者心肌再灌注水平,同时不增加严重出血风险,具有一定的临床应用价值.
Objective To evaluate the efficacy and safety of half-injection recombinant human TNK tissue plasminogen activator(rhTNK-tPA)thrombolysis for myocardial reperfusion in elderly patients with acute ST-segment elevation myocardial infarction(STEMI).Methods Eighty elderly patients(≥60 and<75 years)with STEMI who received thrombolytic therapy were randomly divided into observation group and control group.In 38 cases,the observation group was given a half dose of 8 mg rhTNK-tPA within the thrombolytic time window,and the control group was treated with a conventional amount of 16 mg rhTNK-tPA.The clinical efficacy,bleeding events,and serious adverse events were compared between the two groups.Results There was no statistical difference between the TIMI blood flow grade 2-3 ratio,TIMI blood flow grade 3 ratio,2 h ECG ST segment fallback>50%in the observation group and the control group[TIMI blood flow grade 2-3 ratio:18 cases(81.81%)and 17 cases(85%),P=0.487;TIMI grade 3 ratio:14 cases(63.63%)and 13 cases(65%),P=0.552;ST segment of ECG fallback>50%:16 cases(80%)and 15 cases(83.3%),P=0.527].Within 1 month after thrombolysis,the incidence of serious adverse events was not significantly different between the two groups(P>0.05);intracranial hemorrhage was not significant difference[1 case(2.38%)and 1 case(2.63%),P=0.972];gastrointestinal bleeding event observation group was lower than the control group[gastrointestinal bleeding:3 cases(7.14%)and 7 cases(18.42%),P=0.032];Minor/micro bleeding events(subcutaneous hemorrhage,gum bleeding,puncture site hematoma,urinary tract bleeding)in the observation group were lower than those in the control group[subcutaneous bleeding:3 cases(7.14%)and 6 cases 15.78%),P=0.041;Gingival bleeding:2 cases(4.76%)and 6 cases(15.78%),P=0.039;1 case(2.38%)and 4 cases(10.52%)of puncture site hematoma,P=0.031;Urinary tract bleeding:4 cases(9.52%)and 8 cases(21.05%),P=0.028].Conclusion In elderly patients(>75 years)with acute STEM I,half-injection of rhTNK-tPA thrombolytic therapy has the same effect as thrombolysis and safety is better than the full amount.Appropriate choice for elderly(≥60 and<75 years)STEMI patients;can improve myocardial reperfusion level in elderly(≥60 and<75 years)STEMI patients without increasing the risk of severe bleeding,which has certain clinical application value.
作者
陈国军
黄永坤
何永能
李国强
张建武
CHEIS Guo-jun;HUANG Yong-kun;HE Yong-neng;LI Guo-qiang;ZHANG Jian-wu(Department of Cardiology,Nanfang Hospital,Southern Medical University,Guangzhou 510515,Guangdong,China;不详)
出处
《广东医学》
CAS
2020年第15期1544-1547,共4页
Guangdong Medical Journal
基金
国家自然科学基金资助项目(31700844)。
