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目的 :观察重组葡激酶 (r SAK)在急性心肌梗死 (AMI)患者中的溶栓疗效。方法 :入选AMI患者 5例 ,年龄 <6 0岁 ,胸痛持续 <6h。冠状动脉造影 (CAG)明确梗死相关血管后 ,予r SAK 15mg静脉溶栓结合静脉肝素抗凝治疗 ,在溶栓后 15、30、45、6 0、90min ,1～ 2周重复CAG ,观察溶栓后梗死相关血管TIMI血流和残余狭窄 ,记录胸痛缓解情况、再灌注心律失常、ST段的演变、心肌酶峰值时间、相关并发症及心脏事件。结果 :CAG显示右冠状动脉近端病变和第一对角支近端病变各 1例 ;前降支近端病变 3例 ,溶栓前均完全闭塞。r SAK溶栓后血管再通率 10 0 % ,90min血流达TIMIⅢ级者 2例 ,TIMIⅡ～Ⅲ级者 2例 ,TIMIⅡ级者 1例 ,平均再通时间为(34 .0± 14.7)min。 5例均符合临床冠状动脉再通标准。随访中未见严重出血和心脏事件发生。结论 :r SAK 15mg静脉溶栓有较佳的效果 ,患者有良好的耐受性。
Objective: To observe the thrombolytic effect of recombinant staphylokinase (r SAK) in patients with acute myocardial infarction (AMI). Methods: Five patients were enrolled in AMI. The patients were less than 60 years old and had chest pain lasting for 6 hours. Coronary artery angiography (CAG) infarct-related vascular clear to r SAK 15mg intravenous thrombolysis combined with intravenous heparin anticoagulant therapy, 15,30,45,6 0,90 min after thrombolysis, 1 to 2 weeks repeat CAG, observed Post-infarct-related vascular TIMI flow and residual stenosis were recorded chest pain relief, reperfusion arrhythmia, ST segment evolution, peak myocardial enzyme time, related complications and cardiac events. Results: CAG showed proximal lesions in the right coronary artery and proximal lesions in the first diagonal branch in 1 case, and proximal lesions in the anterior descending branch in 3 cases, all of which were completely occluded before thrombolysis. The recanalization rate of SAK after thrombolysis was 100%. There were 2 cases with TIMI grade Ⅲ in 90 minutes, 2 cases with TIMIⅡ ~ Ⅲ grade and 1 case with TIMIⅡ grade. The mean recanalization time was (34.0 ± 14.7) min . 5 cases were in line with clinical standards for recanalization. No serious bleeding and cardiac events occurred during follow-up. Conclusion: The r SAK 15mg intravenous thrombolysis has a better effect, patients have good tolerance.