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目的评价急诊科内应用重组组织型纤溶酶原激活剂（ｒｔ－ＰＡ）静脉溶栓治疗急性心肌梗死（ＡＭＩ）的疗效及安全性。方法４４例ＡＭＩ患者在急诊科内接受ｒｔ－ＰＡ静脉溶栓治疗。ｒｔ－ＰＡ总量原则为“三级剂量，开通则停”。即当临床显示血管再通时将剂量限制在５０ｍｇ、７５ｍｇ及１００ｍｇ，特殊情况适当加量。负荷量及余量输注速率视梗死部位而异。结果药物总量达５０ｍｇ、７５ｍｇ及１００ｍｇ时血管再通率分别为５９％、７７％及８４％。３例并发心源性休克患者剂量达１００ｍｇ后无再通且病情恶化，分别追加５０ｍｇ、５０ｍｇ及１００ｍｇ后血管再通且存活。总再通率为９１％。轻度出血率为２７％，无严重及颅内出血。结论提示在急诊科内应用ｒｔ－ＰＡ静脉溶栓治疗ＡＭＩ安全有效。
Objective To evaluate the efficacy and safety of intravenous thrombolysis with recombinant tissue plasminogen activator (rt-PA) in the treatment of acute myocardial infarction (AMI) in the emergency department. Methods 44 patients with AMI received rt-PA intravenous thrombolysis in the emergency department. rt-PA total principle for the “three dose, open the stop.” That is, when the clinical recanalization dose limits the dose of 50mg, 75mg and 100mg, special circumstances appropriate dosage. Load and balance Infusion rate varies depending on the infarct site. Results The total recanalization rates were 59%, 77% and 84% when the total amount of drugs reached 50mg, 75mg and 100mg, respectively. Three patients with cardiogenic shock did not recanalize and their condition deteriorated after the dosage of 100 mg was reached. The recanalizations of 50 mg, 50 mg and 100 mg respectively were obtained and survived. The total recanalization rate is 91%. Mild bleeding rate of 27%, no serious and intracranial hemorrhage. The conclusions suggest that rt-PA intravenous thrombolysis in the emergency department is safe and effective.