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急性心肌梗死溶栓疗效判断中血清酶测定时间的合理选择

Reasonable time selection of serum enzymes determination in assessing the efficacy of thrombolytics in patients with acute myocardial infarction

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【作者】 张宝娓； 丁文惠； 张钧华；

【Author】 Zhang Baowei *,Ding Wenhui *,Zhang Junhua *\ \ Endocardial Department,First Hospital of Beijing Medical University 100034

【机构】 北京医科大学第一医院心内科!100034；

【摘要】 目的　适时合理选择急性心肌梗死 (AMI)溶栓疗效判断中血清酶学指标。方法　回顾性分析 145例AMI溶栓患者血清酶学及心肌肌钙蛋白T(TnT)资料 ,其中男 10 7例 ,女 38例 ,平均年龄 (6 1 9± 9 3)岁。以无创指标判断溶栓成功者 110例 ,未成功者 35例。 6 5例行冠脉造影 ,梗死相关血管 (IRA)开通者 44例 ,未开通者2 1例。 5 9例同时测定TnT。结果　 (1)TnT首次异常检出率 84 7% ,高于肌酸磷酸激酶 (CK)同功酶 (CK -MB)(4 9 2 % ) (P <0 0 5 )。 (2 )溶栓成功、IRA开通者与溶栓未成功、IRA未开通者间CK/CK -MB峰值无显著性差异 (P >0 0 5 )。结论　 (1)TnT用于AMI心肌损伤早期诊断优于CK -MB。 (2 )CK/CK -MB峰值前移与溶栓成功与否、IRA开通与否有关 ,而CK/CK -MB峰绝对值与此无直接关系。对早期溶栓的AMI患者不必过早取血测定CK/CK -MB ,而在发病后 16～ 2 0h间取血测定即可满足判断酶峰是否前移的需要 ,从而减轻病人痛苦和经济负担。

【Abstract】 Objective To select reasonable time of determining serum enzymes in assessing the efficacy of thrombolytic therapy in patients with acute myocardial infarction(AMI).Methods One hundred and fourty-five patients with AMI treated with thrombolytics were included.Male 107,female 38,with mean age of(61 9±9 3)years old.The treatment was successful in 110 patients and unsuccessful in 35 patients,judged by clinical standards.Coronary angiogram was done in 65 patients,showing the infarct-related artery patent in 44 patients and closed in 21 patients.Cardiac troponin T(TnT) was determined in 59 patients at