急性心肌梗塞心肺复苏后溶栓治疗

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1、急性心肌梗塞心肺复苏后溶栓治疗　　【摘要】　目的　探讨急性心肌梗塞心肺复苏后溶栓治疗的可行性、必要性及预后。方法　急性心肌梗塞并发心脏骤停的患者22例。治疗组13例，心肺复苏后即刻静脉予尿激酶120～200万U、链激酶150万U或rt-PA50mg溶栓治疗，部分行冠状动脉造影检查。对照组9例，在心肺复苏后予除溶栓外的积极抢救治疗。结果　治疗组13例中11例复苏后溶栓再通，占84.6。住院死亡3例(20.1%)。9例随访3.3±1.5(1～6)年，3例死亡。对照组心肺复苏48小时后无一例存活。两组急救存活率有显著性差异(P＜0.001)。结论　在

2、没有条件实行急诊血管重建的医院，急性心肌梗塞心肺复苏后溶栓治疗能明显提高其住院存活率。　　【关键词】　急性心肌梗塞　　心肺复苏　　溶栓治疗ThrombolytictreatmentofacutemyocardialinfarctionfollowingcardiopulmonaryresuscitationBaiShugong,LiZhizhong,LiLi(InstituteofBeijingHeart,LungandBloodVesselDisease,AnZhenHospital,Beijing100029)【Abstract】　Obje

3、ctive　Toevaluatefeasibility,necessity,prognosisofthrombolytictreatmentfollowingcardiopulmonaryresuscitationofthepatientswithacutemyocardialinfarction.Methods　Twentytwopatientswithacutemyocardialinfarctioncomplicatedwithcardiacarrestweredividedinto2groups,onereceivingintraven

4、ousthrombolytictreatmentandtheotherwascontrolgroup.Inthethrombolyticgrouptherewere13patients.Theyweretreatedwithintravenouslyurokinase1.2～2.0millionUorstreptokinase1.5millionUorrecombinanttissue-typeplasminaogenactivator50mgrightaftercardiopulmonaryresuscitationandperformedc

5、oronaryarteriographiesandfolloweduptoevaluateefficiencyandprognosis.9patientsactedascontrols,theyweregivengeneraltreatmentsexceptfromthrombolysisaftercardiopulmonaryresuscitation.Results　Therewereelevenrecanalizationsduetothrombolysisaftercardiopulmonaryresuscitation(86.4%)i

6、nthrombolyticgroup.In-hopsitalmortalitywas20.08%(3of13patients),ninepatientswerefollowedupfor3.30±1.50(range1～6)years,3casesdied.Nopatientsurvivedin48hoursaftercardiopulmonaryresuscitationincontrolgroup.Therewassignificantlystatisticaldifferenceinsurvivalratebetweentwogroups

7、(P＜0.001).Conclusions　ThrombolytictreatmentcanimprovethesurvivalrateforpatientswithAMIfollowingcardiopulmonaryresuscitationin,especiallyinthosehospitalswithoutconditionperformingemergencyrevascularization.　　【Keywords】　Acutemyocardialinfarction　　CardiopulmonaryresuscitationTh

8、rombolytictherap　　既往心肺复苏是急性心肌梗塞(acutemyocardialinfarction,AMI)患者溶栓治疗的禁忌症，但近