摘要
为探讨尿激酶（ Ｕ Ｋ） 剂量、病人年龄、开始溶栓时间及辅佐硫酸镁（ Ｍ Ｓ） 对溶栓疗效的影响，３２２例急性心肌梗塞（ Ａ Ｍ Ｉ） 中的１５１ 例随机分为 Ｕ Ｍ 组（ Ｕ Ｋ＋ Ｍ Ｓ，７６ 例） 和 Ｕ Ｋ 组（７５ 例） ；未用 Ｍ Ｓ 的２４６ 例又按剂量分成１００ 万ｕ（ Ⅰ） 、１５０ 万ｕ（ Ⅱ） 、２００ 万ｕ（ Ⅲ） 组，按年龄分成６０ 岁（ Ⅳ） 、６１ ～７０ 岁（ Ⅴ） 、＞ ７０ 岁（ Ⅵ）组，按发病时间分成２ ｈ（ Ａ） 、２ ．１ ～４ ｈ（ Ｂ） 、４ ．１ ～６ ｈ（ Ｃ） 、６ ．１ ～１２ ｈ（ Ｄ） 组。结果为 Ｕ Ｍ 组病死率及治疗后主要并发症均低于 Ｕ Ｋ 组；Ⅰ组的疗效与Ⅱ、Ⅲ组相近，而出血少而轻；虽Ⅵ组的病死率高于Ⅳ组（ Ｐ＜ ０ ．０５） 、 Ｄ 组的再通率低于 Ａ 组（ Ｐ＜ ０ ．０１） ，但Ⅵ组及 Ｄ 组疗效也较满意。提示 Ｕ Ｋ１００ 万ｕ ３０ ｍｉｎ 内静滴是安全有效的；高龄（ ＞ ７０ 岁） 患者及发病６ ．１ ～１２ ｈ 溶栓仍有较大价值； Ｍ Ｓ 可作为一种有效的溶栓辅助剂。
Compare the efficacy of UKNU(Nanjing University Pharmaceutic Factory)with UKTP(Guangdong Techpool Biochemical Pharmaceutic Co.Ltd).on acute myocardial infarction(AMI),and study the influences of various factors for thrombolysis,322 cases of AMI admitted to hospitals from December 1991 to January 198 were treated with UKNU(n=142) or UKTP(n=180).151 cases of them were randomly divided into urokinase(UK,75 cases)and UK plus magnesium sulfate(UM,76 cases)groups.In UM group,magnesium sulfate(MS) was begun to use at 15 minute byfore intravenous UK.According to the different dose of UK,patients′ages and starting time of thrombolysis,respectively,246 cases without MS were divided into 1 million U(Ⅰ),1.5 million U(Ⅱ),2 million U(Ⅲ),≤60 years(Ⅳ),61～70 years(Ⅴ),>70 years(Ⅵ),≤2 hours(A),2.1～4 hours(B),4.1～6 hours(C) and 6.1～12 hours(D) groups.The results showed the mortality in patients with patency was 1.9% versus 19.8% in those without (P<0.001).The efficacy and safety of UKNU was similar to UKTP.The patency rate was higher (but P>0.05) and the mortality was lower(P<0.05) in UM group than in UK group.The efficacy of Ⅰ group was similar to Ⅱ and Ⅲ groups(all P>0.05).The mortality in Ⅳ group was 6.4% vs 16.7% in Ⅵ group(P<0.05).The patency rate was lower (P<0.01) in D group(51.2%) than in A group(80%),but the mortality and safety had not obvious difference(all P>0.05) in A～D groups.These data indicate that intravenous UK 1 millilon U within 30 minutes for AMI may be equally effective and safer;delayed thrombolysis(6.1～12 hours after onset of AMI) and elderly patients(aged>70 years as well as>60 years)with intraveous UK have still major value;MS may be safe and valuable adjunct for thrombolytic therapy.
关键词
心肌硬塞
溶栓治疗
尿激酶
硫酸镁
myocardial infarction
thrombolysis
urokinase
magnesium sulfate
