摘要
[摘要]目的观察使用不同剂量的直接凝血酶抑制剂（瑞替普酶）治疗急性心肌梗死（AMI）引发颅内出血（ICH）的发生率。方法研究对象为2009—05—2014—12在我院心内科就诊的AMI患者，其中符合研究要求的有8842例，患者随机分为两组，分别采用不同溶栓治疗方案，对照组使用瑞替普酶（10U剂量，两次用药，间隔30min）和标准剂量的肝素（5000U剂量，体质量I〉80kg的患者注射1000U／h，体质量〈80kg的患者注射800U／h），试验组使用阿昔单抗[剂量0．25mg／kg，以0．125μg／（kg·min）的速度注射]与半量瑞替普酶（5U剂量，两次用药，间隔30min）和减量肝素[60U／kg，最大剂量不超过5000U，以7U／（kg·h）速度注射]联合用药，对两组患者的ICH率及影响因素进行观察。结果试验组ICH发生率明显低于对照组（1．3％vs．0．4％；OR=3．05，95％CI：0．71—3．56）。试验组中，从开始用药到ICH之间的时间间隔中位数为5．5（3．4—11）h，对照组为9．2（5．9—22）h，P=0．048。在与ICH相关的多变量预测指征中，年龄与ICH之间存在显著的相关性（x^2=4．60，P=0．032），年轻患者出血风险低，而年长患者ICH风险高。结论瑞替普酶半量治疗能降低整个患者群体ICH的风险，年龄与出血治疗风险之间关系显著，年轻患者治疗风险较低，年长患者治疗风险较高，应采用半量治疗。
Objective To observe the incidence of intracranial hematoma caused by different doses of glycoprotein IIb/IIIa inhibitors （reteplase） in the treatment of acute myocardial infarction. Methods The research objects were acute myocardial infarction patients who were treated in the Department of Cardiology from May 2009 to December 2014 in our hospital. 8842 patients which meet the research requirements were randomly divided into two groups, respectively, with different thrombolytic treatment scheme. The control group used reteplase （dose： 10 U, twice, interval： 30 min） and standard dose of heparin （weight more than 80 kg per hour of injection of 1000 U patients, and the weight 〈 80 kg patients per hour of injection 800 U） ; while the experimental group used the Asif MAb [ dose 0.25 mg/ kg, at a speed of 0. 125 μg/（kg · min）] and half dose reteplase （dose：5 U, twice, interval： 30 min） and reduction of heparin （60 U/kg） the maximum dose of not more than 5000 U, with a rate of 7 U/（kg. h） injection combination. The incidence and risk factors of intracranial hemorrhage of two groups were observed. Results In the experimental group the incidence of intracranial hemorrhage was significantly lower than the control group （1.3% vs. 0.4% ; OR = 3.05, 95% CI： 0.71 - 3.56）. In the experimental group, the median interval from the start of treatment to intracranial hemorrhage was 5.5 （ 3.4 - 11 ） h, 9.2 hour in the control group （5.9 - 22） （P = 0.048）. Among the multi variables associated with intracranial hemorrhage predictive indications, there is a significant correlation between age and treatment of bleeding （ x^2 = g. 60, P = 0.032）, young patients had a low risk of bleeding in the treatment. Con^luslon Reteplase with half amount of treatment can drop the intracranial hemorrhage risk in whole case and the relationship between age and treatment of bleeding risk is significantly, so older patients are in higher risk and should be treated by the semi quantity therapy.
出处
《中国急救医学》
CAS
CSCD
北大核心
2016年第3期242-245,共4页
Chinese Journal of Critical Care Medicine
