本文選題：急性心肌梗死 + 溶栓治療　； 參考：《山東大學(xué)》2017年碩士論文

【摘要】：目的:本文旨在通過收集臨床病例,對急性ST段抬高型心肌梗死的患者使用尿激酶原進(jìn)行溶栓,分析和評價尿激酶原的臨床療效。方法:隨機選取新泰市人民醫(yī)院心內(nèi)科急性ST段抬高型心肌梗死(AMI)患者100例,其中50例作為實驗組,給予尿激酶原溶栓;50例作為對照組,給予尿激酶溶栓。分別觀察兩組不同時間段的血管再通率,心肌酶峰值、達(dá)峰時間,并發(fā)癥,出血率以及住院期間的病死率。結(jié)果:1.兩組患者在年齡、性別、危險因素(包括高血壓、糖尿病、高血脂、吸煙、肥胖)、入院時的心臟功能、發(fā)病至溶栓開始時間等方面,差異無統(tǒng)計學(xué)意義(P0.05)。2.尿激酶原組患者30min、60min、90min、120min再通率分別為10.00%、52.00%、80.00%、84.00%。尿激酶組患者 30min、60min、90min、120min 再通率分別為8.00%、30.00%、60.00%、62.00%。尿激酶原組各個時間段的再通率均高于尿激酶組,兩組比較差異有統(tǒng)計學(xué)意義(P均0.05)。3.尿激酶原組梗死相關(guān)動脈再通率為70.00%,尿激酶組梗死相關(guān)動脈再通率為58.00%,兩組再通率比較差異有統(tǒng)計學(xué)意義(P0.05)。4.尿激酶原組LVEF平均值為(55.95±10.23)%,尿激酶組平均值為(51.25±11.77)%,尿激酶原組明顯高于尿激酶組,兩組比較,差異有統(tǒng)計學(xué)意義(P0.05)。5.尿激酶原組CKMB峰值為(133.00±178.00)U/L,達(dá)峰時間為(8.2±4.50)h、CTnI 峰值為(12.50±10.26)ng/mL,尿激酶組為 CKMB 峰值為(160.00±132.00)U/L,達(dá)峰時間為(11.5±15)h、CTnI 峰值為(16.66±10.30)ng/mL。與尿激酶組相比較,尿激酶原組CKMB達(dá)峰時間提前、CKMB峰值和CTnI峰值降低,差異均有統(tǒng)計學(xué)意義(P均0.05)。6.尿激酶原組與尿激酶組相比較,能明顯降低室壁瘤、嚴(yán)重心律失常、心力衰竭、梗死后心絞痛、血管再閉塞的發(fā)生,兩者比較,差異有統(tǒng)計學(xué)意義(P0.05),但在心包積液形成方面,兩者比較差異無統(tǒng)計學(xué)意義(P0.05)。7.尿激酶組消化道出血的有4例,占8.00%,腦出血的有1例,占2.00%,牙齦出血的有2例,占4.00%,尿激酶原組消化道出血有1例,占2.00%,腦出血的為0例,牙齦出血的有1例,占2.00%。尿激酶原組總出血的發(fā)生率明顯低于尿激酶組,兩者比較差異有統(tǒng)計學(xué)意義(P0.05)。8.尿激酶組有2例患者住院期間死亡,占4.00%,尿激酶原組有1例患者住院期間死亡,占2.00%,兩者比較差異無統(tǒng)計學(xué)意義(P0.05)。結(jié)論:1.尿激酶原溶栓治療急性ST段抬高型心肌梗死,與尿激酶相比,再通率高,并發(fā)癥發(fā)生率低,死亡率低。2.尿激酶原榕栓治療急性ST段抬高型心肌梗死,與尿激酶相比,出血率低,相對比較安全。
[Abstract]:Objective: to analyze and evaluate the clinical efficacy of urokinase prothrombolytic therapy in patients with acute ST-segment elevation myocardial infarction by collecting clinical cases.Methods: 100 patients with acute St segment elevation myocardial infarction (AMI) in Department of Cardiology, Xintai people's Hospital, were randomly selected, 50 of them were treated as experimental group, 50 patients were given urokinase thrombolytic therapy as control group, and urokinase thrombolytic therapy was given to 50 patients.The vascular recanalization rate, peak myocardial enzyme peak, peak time, complications, bleeding rate and mortality during hospitalization were observed in the two groups.The result is 1: 1.There was no significant difference in age, sex, risk factors (including hypertension, diabetes, hyperlipidemia, smoking, obesity, heart function at admission, onset time from onset to thrombolysis) between the two groups.The recanalization rates of patients with urokinase were 10.00 and 52.00 in 30 min, 60 min and 90 min / 120 min, respectively.In the urokinase group, the recanalization rates of 60 min / 90 min / 120 min were respectively 8.00 and 30.000.000 / 62.00, respectively.The recanalization rate of urokinase in each time period was higher than that in urokinase group, and the difference between the two groups was statistically significant (P < 0.05).The recanalization rate of infarct-related artery in urokinase group was 70.00g, and that in urokinase group was 58.00.The difference between the two groups was statistically significant (P 0.05).The average LVEF of urokinase group was 55.95 鹵10.23, and that of urokinase group was 51.25 鹵11.770.The average value of urokinase group was significantly higher than that of urokinase group. The difference between the two groups was statistically significant (P 0.05).The peak value of CKMB in urokinase group was 133.00 鹵178.00 U / L, the peak time of CKMB was 8.2 鹵4.50 鹵10.26 ng / mL, the peak value of CKMB in urokinase group was 160.00 鹵132.00 渭 L / L, and the peak time of CKMB was 11.5 鹵15hTnI = 16.66 鹵10.30 ng / mL.Compared with urokinase group, the peak time of CKMB in urokinase group was lower than that of urokinase group, and the peak value of CK-MB and CTnI was lower than that of urokinase group (P < 0.05).Compared with urokinase group, urokinase group could significantly reduce the incidence of ventricular aneurysm, severe arrhythmia, heart failure, post-infarction angina pectoris, and vascular re-occlusion. The difference between the two groups was statistically significant (P 0.05), but in the formation of pericardial effusion, there was a significant difference in the formation of pericardial effusion.There was no significant difference between the two groups (P 0.05. 7).There were 4 cases of gastrointestinal hemorrhage in urokinase group (8.00%), 1 case (2.00%) of cerebral hemorrhage, 2 cases (4.00%) of gingival hemorrhage, 1 case (2.00%) of gastrointestinal hemorrhage of urokinase group, 0 case of intracerebral hemorrhage and 1 case (2.00%) of gingival hemorrhage.The incidence of total hemorrhage in urokinase group was significantly lower than that in urokinase group, and the difference between them was statistically significant (P 0.05. 8).In the urokinase group, 2 patients died during hospitalization (4.00%), and one patient died in the original group (2.00%). There was no significant difference between the two groups (P 0.05).Conclusion 1.Urokinase prothrombolytic therapy for acute ST-segment elevation myocardial infarction, compared with urokinase, compared with urokinase, the rate of recanalization is higher, the incidence of complications is low, and the mortality rate is lower than that of urokinase.Compared with urokinase, the rate of bleeding was lower and the treatment of ST-segment elevation myocardial infarction was safe.
【學(xué)位授予單位】：山東大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R542.22

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