目的 观察尿激酶对急性心肌梗死(AMI)患者心肌耗氧量、肌酸磷酸激酶(CK)和心电图变化的影响.方法 入组2012年12月~2014年12月于陕西省榆林市星元医院诊断为AMI患者共122例,根据治疗方式分为对照组(53例)和试验组(69例),所有患者入院后排除溶栓禁忌,对照组患者予支持治疗、静脉注射低分子肝素150万U和口服阿司匹林300 g等常规治疗;试验组予常规治疗基础上使用尿激酶,治疗后持续观察心肌耗氧量情况、肌酸磷酸激酶和ST段变化率(ST段在用药后降低的与用药之前的比值)的变化.结果 经过治疗后试验组患者心电图ST段变化率、血管再通率与对照组比较均有显著差异(P<0.01);经治疗后5 d,两组血压差异不明显(P>0.05),试验组心率、心肌耗氧量明显低于对照组,与对照组同期比较具有统计学差异(P<0.05);经过治疗后试验组患者CK值与对照组同期比较,开始时几乎无差异(P>0.05),而在16 h、20 h、24 h CK值分别为23.32±7.73,17.45±7.44和8.47±3.4有显著差异(P<0.05);经过治疗后试验组患者CK酶峰与对照组比较有显著差异(P<0.05),试验组峰值前移小于16 h.结论 尿激酶联合阿司匹林治疗老年心肌梗死患者效果确实可靠.
Objective To observe the influences of urokinase on myocardial oxygen consumption, creatine kinase (CK) and electrocardiogram (ECG) in patients with acute myocardial infarction (AMI).Methods AMI patients (n=122) were chosen from Dec. 2012 to Dec. 2014, and divided into control group (n=53) and test group (n=69). The control group was given supportive therapy, intravenous injection of low molecular weight heparin (1.5 million U) and oral aspirin (300 g), and test group was given additionally urokinase. The changes of myocardial oxygen consumption, CK and ECG ST-segment change rate (ratio of ST-segment decrease after treatment to that before treatment) were observed continuously after treatment. Results After treatment, the difference in ST-segment change rate and revascularization rate was significant between 2 groups (P<0.01). The difference in blood pressure was not significant between 2 groups (P>0.01), and heart rate and myocardial oxygen consumption were significantly lower in test group than those in control group (P<0.05). The difference in CK was not significant at the first between 2 groups (P>0.05) after treatment, and after 16 h (23.32±7.73), 20 h (17.45±7.44) and 24 h (8.47 ±3.4) the difference was significant (P<0.05). After treatment, the difference in CK enzyme peak was significant between 2 groups (P<0.05) and forward lead of peak was less than 16 h in test group.Conclusion Urokinase combining aspirin has reliable curative effect on AMI in elderly patients.