鲁杰 马国祥 陈力

【摘要】 目的：探讨重组人组织型纤溶酶原激酶衍生物（rPA）治疗急性ST段抬高型心肌梗死的效果和安全性。方法：选取笔者所在医院2017年6月-2018年12月收治的急性ST段抬高型心肌梗死患者116例，根据随机数字表法分为试验组（58例）及对照组（58例）。试验组采用重组人组织型纤溶酶原激酶衍生物，对照组采用尿激酶。比较两组血管再通率、治疗前后凝血酶原时间、纤维蛋白原、D-二聚体变化情况，比较两组治疗后出血事件发生率。结果：试验组治疗后2、6 h血管再通率（70.7%、94.8%）均高于对照组（41.4%、79.3%），差异均有统计学意义（P<0.05）;试验组凝血酶原时间长于对照组，纤维蛋白原、D-二聚体低于对照组，差异均有统计学意义（P<0.05）;試验组出血事件发生率（8.6%）低于对照组（25.9%），差异有统计学意义（P<0.05）。结论：重组人组织型纤溶酶原激酶衍生物治疗急性ST段抬高型心肌梗死的血管再通率较高，溶栓效果较好，出血事件较少，具有较好的临床应用价值及推广意义。

【关键词】 急性ST段抬高型心肌梗死 重组人组织型纤溶酶原激酶衍生物 尿激酶 溶栓

doi：10.14033/j.cnki.cfmr.2020.10.002 文献标识码 A 文章编号 1674-6805（2020）10-000-03

Effect and Safety of Recombinant Human Tissue Plasminogen Kinase Derivatives in Thrombolytic Therapy of Acute ST Segment Elevation Myocardial Infarction/LU Jie， MA Guoxiang， CHEN Li. //Chinese and Foreign Medical Research， 2020， 18（10）： -5

[Abstract] Objective： To investigate the efficacy and safety of Recombinant Human Tissue Plasminogen Kinase Derivative in the treatment of acute ST segment elevation myocardial infarction. Method： A total of 116 patients with acute ST segment elevation myocardial infarction admitted to our hospital from June 2017 to December 2018 were divided into the experimental group （58 cases） and the control group （58 cases） according to the random number table method. The Recombinant Human Tissue Plasminogen Kinase Derivative was used in the experimental group and Urokinase was used in the control group. The rate of recanalization， prothrombin time， fibrinogen and D-dimer were compared before and after treatment， and the incidence of bleeding events was compared between the two groups. Result： Two and six hours after treatment， the recanalization rate in the experimental group （70.7%， 94.8%） were higher than those in the control group （41.4%， 79.3%）， the differences were statistically significant （P<0.05）. The prothrombin time in the experimental group was longer than that in the control group， the fibrinogen and D-dimer in the experimental group were lower than those in the control group， and the incidence of bleeding events in the experimental group （8.6%） was lower than that in the control group （25.9%）， the differences were statistically significant （P<0.05）. Conclusion： The Recombinant Human Tissue Plasminogen Kinase Derivative has a high recanalization rate， good thrombolytic effect and less bleeding events in the treatment of acute ST segment elevation myocardial infarction， which has a better clinical application value and promotion significance.

[Key words] Acute ST segment elevation myocardial infarction Recombinant Human Tissue Plasminogen Kinase Derivative Urokinase Thrombolysis

First-authors address： The Third Peoples Hospital of Shenzhen Baoan Peoples Hospital （Group）， Shenzhen 518103， China

急性ST段抬高型心肌梗死（acute ST segment elevation myocardial infarction，STEMI），是由于心肌血供突然而持久地中断引起的心血管急症[1]，溶栓是治疗STEMI的重要手段之一[2]。尿激酶是常用的溶栓剂，但血管再通率低，出血风险高[3-4]。重组人组织型纤溶酶原激酶衍生物（rPA）是第三代溶栓剂，为纤维蛋白特异性结合剂，可能提高溶栓效果，减少出血事件[5-6]。本研究运用rPA治疗STEMI取得较好的效果，现将结果报道如下。

1 资料与方法

1.1 一般资料

选取笔者所在医院2017年6月-2018年12月收治的STEMI患者116例。纳入标准：明确诊断STEMI;无溶栓禁忌证;入院时间≤6 h。排除标准：存在溶栓禁忌证;患有精神障碍;无法配合溶栓。按照随机数字表法分为试验组（58例）和对照组（58例）。试验组男30例，女28例;平均年龄（54.9±2.6）岁，平均溶栓时间（159.62±47.67）min;长期吸烟21例，高血压17例，糖尿病10例，血脂异常12例。对照组男32例，女26例;平均年龄（55.7±3.3）岁，平均溶栓时间（158.65±48.52）min;长期吸烟19例，高血压20例，糖尿病7例，血脂异常14例。……