急性心肌梗死心肺复苏成功后的溶栓治疗

Thrombolytic treatment of acute myocardial infarction following cardiopulmonary resuscitation

关键词:  急性心肌梗死  心肺复苏  溶栓治疗

Key words:  acute myocardial infarction  cardiopulmonary resuscitation  thrombolytic therapy

摘要:

［目的］探讨急性心肌梗死心肺复苏后溶栓治疗的可行性和必要性。［方法］ 选取急性心肌梗死并发心脏骤停的患者30例。其中11例心肺复苏后即刻静脉予尿激酶150万u溶栓治疗（治疗组）；19例心肺复苏后予积极抢救但无溶栓治疗（对照组）。［结果］ 治疗组11例中9例复苏后溶栓再通,占81.8%（存活7例占63.6%，死亡2例占18.2%）；对照组心肺复苏48 h后无一例存活，两组差异显著（P＜0.01）。存活7例中，6例随访3.3±1.5(1～6)年, 其中2例死亡。［结论］ 在没有条件实行急诊血管重建时,急性心肌梗死心肺复苏后溶栓治疗能明显提高患者存活率。

Abstract:

［Objective］ To evaluate feasibility and necessity of thrombolytic treatment following cardiopulmonary resuscitation of the patients with acute myocardial infarction. ［Methods］ Thirty patients with acute myocardial infarction complicated with cardiacar rest were divided into 2 groups, onereceiving intravenous thrombolytic treatment and the other was control group. In the thrombolytic group there were 11 patients. They were treated with intravenously urokinase 1.5 million u after cardiopulmonary resuscitation followed up toevaluate efficiency and prognosis. 19 patients acted as controls, they were given general treatments except from thrombolysis after cardiopulmonary resuscitation. ［Results］ There were nine recanalizations due to thrombolysis after cardiopulmonary resuscitation (81.8%) in thrombolytic group. In hopsital survival ratewas 63.6% (7 of 11 patients) and mortality was 18.2% (2 of 11 patients); No patient survived in 48 hours after cardiopulmonary resuscitation in control group.There was significantly statistical difference in survival rate between two groups (P<0 .01). Among the 7 survivals, six patients were followed up for 3. 30±1. 50(range 1～6) years, 2 cases died. ［Conclusions］ Thrombolytic treatment can improve the survival rate for patients with AMI following cardiopulmonaryresuscitation, especially in those hospitals without condition performing emergency revascularization.