杨夏彤 陈科全 苏宁

[摘要]目的 观察阿替普酶靜脉溶栓联合氯吡格雷、阿司匹林治疗急性ST段抬高型心肌梗死的临床效果。方法 选取我院门诊及急诊2016年1月～2018年1月收治的66例急性ST段抬高型心肌梗死患者，患者均给予阿替普酶静脉溶栓联合氯吡格雷、阿司匹林治疗。根据发病时间，将患者分为6 h组（n=45）和>6～12 h组（n=21）。比较两组患者治疗后的冠脉再通率及溶栓后24 h 的APACHEⅡ评分。结果 6 h组的冠脉再通率（59.09%），明显高于>6～12 h组的18.18%（P<0.05）。两组患者溶栓后24 h 的APACHEⅡ评分比较，差异有统计学意义（P<0.05）。结论 阿替普酶静脉溶栓联合氯吡格雷、阿司匹林治疗急性ST段抬高型心肌梗死安全有效，越早进行溶栓，越能改善患者的预后。

[关键词]阿替普酶；氯吡格雷；心肌梗死；ST段抬高型

[中图分类号] R542.2+2 [文献标识码] A [文章编号] 1674-4721（2018）7（a）-0161-03

[Abstract]Objective To observe the clinical effect of intravenous thrombolysis with Alteplase combined with Clopidogrel and Aspirin treating acute ST segment elevation myocardial infarction.Methods A total of 66 patients with acute ST-segment elevation myocardial infarction admitted into our hospital from January 2016 to January 2018 were selected.All patients were treated by intravenous thrombolysis with Alteplase combined with Clopidogrel and Aspirin.The patients were divided into the 6 h group （n=45） and >6-12 h group （n=21） according to the time of onset.Coronary recanalization rate after treatment and APACHEⅡscore at 24 h after thrombolysis were compared in patients between the two groups.Results The coronary recanalization rate （59.09%） in the 6 h group was significantly higher than that in the >6-12 h group （18.18%） （P<0.05），and the APACHEⅡ score at 24 h after thrombolysis were significantly different between the two groups （P<0.05）.Conclusion intravenous thrombolysis with Alteplase combined with Clopidogrel and Aspirin treating acute ST segment elevation myocardial infarction is safe and effective treating acute ST segment elevation myocardial infarction，and the sooner thrombolysis is performed，the better the prognosis of patients.

[Key words]Alteplase；Clopidogrel；Myocardial infarction；ST segment elevation

急性ST段抬高型心肌梗死（STEMI）是冠状动脉内血栓形成的严重的急性心血管事件[1]，治疗方法为急诊行经皮冠状动脉介入或药物溶栓治疗。抗栓治疗对于治疗的全过程至关重要。2012年以来，欧洲心脏病学会（ESC）、美国心脏病学会基金会（ACCF）以及美国心脏协会（AHA）相继公布了STEMI新版指南[2-3]，急性STEMI一旦确诊，应立即行抗血小板及抗凝治疗。目前公认，在不具备PCI条件的医院或因各种原因使FMC至PCI时间明显延迟时，对有适应证的STEMI患者，静脉内溶栓仍是较好的选择。对发病内3 h内的患者，溶栓治疗的即刻疗效与直接PCI基本相似。溶栓治疗药物建议优先采用特异性纤溶酶原激活剂如重组组织型纤溶酶原激活剂阿替普酶、兰替普酶、瑞替普酶和替奈普酶等。本研究探讨阿替普酶静脉溶栓与氯吡格雷、阿司匹林治疗STEMI的效果，印证其对急性心肌梗死早期治疗和预后均安全有效，并且宜尽早进行。

1 资料与方法

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