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目的探讨不同疗程小剂量尿激酶对急性心肌梗死经静脉溶栓再通后心绞痛患者心肌再灌注及心功能的影响。方法采用前瞻、随机、双盲、对照研究方法,将符合入选标准的160例梗死后心绞痛患者随机分为3组观察组:3d组40例,5d组39例,7d组41例,常规强化治疗加尿激酶0.5万U.kg-1.d-1静脉滴注3,5,7d,,对照组40例常规强化治疗。第7d统计心绞痛缓解程度,第2周计算心肌梗死面积,第1月观察左心室射血分数(LEVF)及心室壁运动记分(WMSI)。结果观察组7d组心绞痛缓解程度优于对照组有显著性差异(P<0.05),第2周心肌梗死面积观察组较对照组减少(P<0.05),观察组间亦有显著性差异(P<0.05)。第1月观察组LVEF较对照组无显著性差异(P>0.05),但LVEF值高于对照组,观察组间LVEF亦无显著性差异(P>0.05),但多d组LVEF高于少d组。第1月WMSI观察组较对照组减少(P<0.05),观察组间亦有显著性差异(P<0.05)。结论小剂量尿激酶治疗梗死后心绞痛,心绞痛缓解程度和心肌梗死面积减小明显,LVEF值虽然无显著性差异,但WMSI改善明显。在未开展经皮冠状动脉介入治疗(PCI)的地区长疗程小剂量尿激酶治疗梗死后心绞痛不失为一种有效改善心肌再灌注及心功能的好方法。
Objective To investigate the effects of different doses of low-dose urokinase on myocardial reperfusion and cardiac function in patients with acute myocardial infarction after intravenous thrombolysis and reoperation. Methods According to the prospective, randomized, double-blind and controlled study, 160 patients with post-infarction angina pectoris who meet the inclusion criteria were randomly divided into 3 groups: 40 cases in 3d group, 39 cases in 5d group and 41 cases in 7d group. Conventional intensive treatment Plus urokinase 0.5 million U.kg-1.d-1 intravenous infusion 3,5,7 d ,, control group of 40 cases of conventional intensive treatment. The severity of angina pectoris was determined on the 7th day, the area of myocardial infarction was calculated on the 2nd week, the left ventricular ejection fraction (LEVF) and the ventricular wall motion score (WMSI) were observed in the 1st month. Results The severity of angina pectoris in observation group was better than that in control group at 7d (P <0.05), the area of myocardial infarction in observation group at 2d was lower than that of control group (P <0.05), and there was significant difference between observation group (P <0.05). There was no significant difference in LVEF between the observation group and the control group (P> 0.05), but LVEF was higher in the observation group than in the control group (P> 0.05) d group. The WMSI observation group decreased in the first month (P <0.05) and the observation group also had significant difference (P <0.05). Conclusion Low-dose urokinase treatment of angina pectoris, angina pectoris and myocardial infarction area decreased significantly, although LVEF values were not significantly different, but WMSI improved significantly. In the absence of percutaneous coronary intervention (PCI) in the area of long-term treatment of small doses of urokinase in the treatment of post-infarction angina pectoris is a good way to effectively improve myocardial reperfusion and cardiac function.