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目的探究急性ST段抬高型心肌梗死(ST-segment elevation myocardial infarction,STEMI)行瑞替普酶(r PA)联合还原型谷胱甘肽(glutathione,GSH)的治疗效果。方法选取2013年4月—2014年4月本院诊治的急性STEMI患者72例作为研究对象,随机分为对照组和研究组各36例。对照组患者采用r PA治疗,研究组患者采用r PA联合还原型GSH治疗。观察并比较两组患者治疗后肌酸激酶同工酶(creatine kinase isoenzymes,CKMB)、肌钙蛋白I(cardiac troponin I,c Tn I)、左心室射血分数(left ventricular ejection fractions,LVEF)、左心室舒张末期内径(left ventricular end-diastolic diameter,LVEDd)水平、血管再通情况及不良事件发生情况。计量资料组间比较采用t检验,组内比较采用配对t检验,计数资料采用χ2检验,P<0.05为差异有统计学意义。结果治疗后,研究组与对照组患者CKMB、c Tn I及LVEF水平分别为(50.23±7.58)、(72.58±11.26)U/L、(0.70±0.42)、(1.52±0.10)μg/L、(62.58±8.57)%、(53.26±8.25)%,均较治疗前的(17.58±3.20)、(16.59±2.95)U/L、(0.06±0.04)、(0.05±0.04)μg/L、(48.52±8.20)%、(47.95±7.95)%明显升高;LVEDd水平分别为(51.23±6.20)、(61.20±8.47)mm,均较治疗前的(68.52±9.10)、(68.23±9.58)mm明显降低,差异均有统计学意义(均P<0.05)。治疗后两组间各指标水平比较差异均有统计学意义(均P<0.05)。研究组再梗死、心绞痛及心律失常发生率分别为2.78%、5.56%、2.78%,均低于对照组的22.22%、30.56%、27.78%,差异均有统计学意义(均P<0.05)。结论 r PA联合还原型GSH治疗STEMI疗效显著,同时可降低不良事件发生率。
Objective To investigate the therapeutic effect of reteplase (r PA) combined with glutathione (GSH) in acute ST-segment elevation myocardial infarction (STEMI). Methods Seventy-two patients with acute STEMI diagnosed and treated in our hospital from April 2013 to April 2014 were selected as study subjects and randomly divided into control group and study group with 36 cases each. Patients in the control group were treated with r PA and patients in the study group were treated with r PA combined with reduced GSH. The levels of creatine kinase isoenzymes (CKMB), cardiac troponin I (cTn I), left ventricular ejection fractions (LVEF) Left ventricular end-diastolic diameter (LVEDd) level, recanalization and adverse events. Measurement data were compared between groups using t test, the group was compared using paired t test, count data using χ2 test, P <0.05 for the difference was statistically significant. Results After treatment, the levels of CKMB, cTn I and LVEF in study group and control group were (50.23 ± 7.58), (72.58 ± 11.26) U / L, (0.70 ± 0.42) and (1.52 ± 0.10) μg / L, (62.58 ± 8.57)% and (53.26 ± 8.25)% respectively, which were significantly higher than those before treatment (17.58 ± 3.20), (16.59 ± 2.95) U / L, 0.06 ± 0.04 and 0.05 ± 0.04 μg / 48.52 ± 8.20%, and 47.95 ± 7.95% respectively. The LVEDd levels were (51.23 ± 6.20) and (61.20 ± 8.47) mm respectively, which were significantly higher than those before treatment (68.52 ± 9.10) and (68.23 ± 9.58) mm Significantly lower, the difference was statistically significant (all P <0.05). After treatment, the levels of each index between the two groups were statistically significant (P <0.05). The incidences of reinfarction, angina pectoris and arrhythmia were 2.78%, 5.56% and 2.78% in the study group, which were all lower than those in the control group (22.22%, 30.56% and 27.78%, both P <0.05). Conclusion r PA combined with reduced GSH treatment of STEMI significant effect, while reducing the incidence of adverse events.