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目的 :调查初发急性心肌梗死 (AMI)溶栓疗法的应用现状及近期疗效。方法 :总结我院 1996 - 0 1～ 1999- 0 8期间所有确诊初发 AMI患者的临床资料 ,发病超过 2 4h入院、外院转来、心内膜下心梗、再梗患者除外。结果 :2 0 2例初发 AMI患者中 ,148例 (73.3% )符合溶栓适应证 ,132例 (6 5 .3% )应用溶栓疗法 ,36例 (2 4.3% )未溶栓 (16例 )或溶栓药物剂量不足 (2 0例 )。 70例未溶栓患者中 ,发病—入院 >12 h、符合适应证而未予溶栓、溶栓禁忌、入院心电图不能确诊 AMI的比例分别为 6 0 .0 % ,2 2 .8% ,8.6 %和 8.6 %。溶栓组住院期间病死率显著低于未溶栓组(6 .1% vs15 .7% ,P<0 .0 5 ) ,其中再通组病死率显著低于未通组 (2 .3% vs2 0 .8% ,P<0 .0 1)。结论 :尽管溶栓疗法改善了 AMI的近期预后 ,但合理应用溶栓疗法的比例仍有待提高 ,患者入院过迟、溶栓治疗不积极是溶栓疗法应用偏低的主要原因。
Objective: To investigate the application status and short-term curative effect of initial thrombolytic therapy of acute myocardial infarction (AMI). Methods: The clinical data of all newly diagnosed AMI patients in our hospital from 1996 to 2001-99-88 were summarized. The patients were admitted after more than 24 hours and were referred to the hospital except the patients with subendocardial myocardial infarction and re-infarction. Results: Of the 202 patients with initial AMI, 148 (73.3%) were eligible for thrombolytic therapy, 132 (65.3%) received thrombolysis, and 36 (22.3% Cases) or insufficient dose of thrombolytic drugs (20 cases). 70 cases of patients without thrombolysis, onset - admission> 12 h, in line with the indications without thrombolysis, thrombolytic taboo, admitted to the electrocardiogram can not be diagnosed AMI were 60.0%, 22.8%, 8.6 % And 8.6%. In the thrombolytic group, the case fatality rate was significantly lower in the thrombolytic group than in the non-thrombolytic group (6.1% vs 15.7%, P <0.05), and the mortality in the recanalization group was significantly lower than that in the unreceived group (2.3% vs2 0 .8%, P <0. 01). CONCLUSIONS: Although thrombolytic therapy improves the short-term prognosis of AMI, the rationale for rational use of thrombolytic therapy remains to be improved. Patients who are hospitalized too late and thrombolytic therapy is less aggressive are the main reasons for the lower use of thrombolytic therapy.