Results of high dose intravenous urokinase for acute myocardial infarction.
Results of high dose intravenous urokinase for acute myocardial infarction.
复制标题
大剂量静脉注射尿激酶治疗急性心肌梗死的结果。
DOI：
10.1016/0002-9149(90)90072-9
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发表时间：
1990
期刊：
影响因子：
--
通讯作者：
Whitcomb,D
中科院分区：
文献类型：
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作者：
Wall,TC;Phillips3rd,HR;Stack,RS;Mantell,S;Aronson,L;Boswick,J;Sigmon,K;DiMeo,M;Chaplin,D;Whitcomb,D
为了确定大剂量静脉尿激酶（300万U）治疗后患者的结局，对102例急性心肌梗死患者进行了前瞻性评价。前61例患者接受静脉尿激酶持续输注，后41例患者接受初始150万U静脉推注治疗。62%的患者在即刻血管造影时（中位时间2.2小时）有通畅的梗死相关动脉，所有患者均进行了血管造影。有或没有初始静脉推注治疗的患者之间的通畅率没有显着差异。28例（28%）患者在住院期间出现复发性缺血的临床证据（死亡、再闭塞、紧急血管成形术、紧急旁路手术），而仅7例（7%）出现血管造影记录的再闭塞。在28名在立即导管插入时未能实现成功再灌注的患者中，除了1名患者外，抢救性血管成形术在技术上成功地建立了所有患者的再灌注。在即刻（48%）和随访导管插入术（48%）之间未观察到中位整体左心室功能的显著改善。除1例患者发生颅内出血外，其他严重出血并发症均不常见。8例（8%）患者在住院期间死亡。因此，在急性心肌梗死患者中使用大剂量静脉内尿激酶与62%的通畅率、低再闭塞和出血并发症发生率以及立即导管插入时补救血管成形术的高技术成功率相关。这项研究支持需要进一步的随机对照试验比较静脉尿激酶直接与其他溶栓方案。
To determine the outcome of patients after treatment with high-dose intravenous urokinase (3 million U) 102 patients were prospectively evaluated in the setting of acute myocardial infarction. The first 61 patients received intravenous urokinase as a continuous infusion and the last 41 patients were treated with an initial 1.5 million U intravenous bolus. Sixty-two percent of all patients had patent infarct-related arteries by the time of immediate angiography (median time 2.2 hours), which was performed in all patients. There was no significant difference in patency rates between patients treated with or without an initial intravenous bolus. Twenty-eight (28%) patients developed clinical evidence of recurrent ischemia (death, reocclusion, emergency angioplasty, urgent bypass surgery) during hospitalization, whereas only 7 (7%) developed angiographically documented reocclusion. Of 28 patients who failed to achieve successful reperfusion at the time of immediate catheterization, rescue angioplasty was technically successful in establishing reperfusion in all but 1 patient. No significant improvement in median global left ventricular function was seen between immediate (48%) and follow-up catheterization (48%). Significant bleednig complications were unusual except in 1 patient who experienced an intracranial hemorrhage. Eight (8%) patients died during hospitalization. Therefore, the use of high-dose intravenous urokinase in patients with acute myocardial infarction is associated with a 62% patency rate, a low incidence of reocclusion and bleeding complications and a high technical success rate with rescue angioplasty at the time of immediate catheterization. This study supports the need for further randomized controlled trials comparing intravenous urokinase directly with other thrombolytic regimens.