急性心肌梗死心脏骤停患者心肺复苏后重组人尿激酶原溶栓治疗效果研究

doi:10.12114/j.issn.1007-9572.2023.0616

摘要/Abstract

摘要： 背景临床实际工作中，部分基层医院不具备开展经皮冠状动脉介入治疗（PCI）的条件，急性心肌梗死（AMI）患者直接行PCI难度大，而心肺复苏（CPR）是溶栓治疗的相对禁忌证。AMI心脏骤停患者是否需要溶栓仍存在争议。目的探讨AMI心脏骤停患者CPR后应用重组人尿激酶原溶栓的临床应用效果、可行性及必要性。方法选取2015年2月—2021年12月河北医科大学第二医院、河北省宁晋县医院、石家庄新乐市人民医院、唐山丰润区人民医院急诊医学科收治的AMI心脏骤停行CPR患者117例为研究对象。依据治疗方法将患者分为2组：非溶栓治疗组（17例）和溶栓治疗组（100例）。非溶栓治疗组给予呼吸循环支持、抗凝、扩血管、抗心律失常、抗休克等对症综合治疗，溶栓治疗组在非溶栓治疗组的治疗基础上应用重组人尿激酶原溶栓，溶栓治疗均在时间窗内进行，通过电子病历系统收集患者临床资料及预后情况并进行比较。结果非溶栓治疗组中17例患者均抢救无效死亡。溶栓治疗组患者死亡15例（15.0%），存活85例（85.0%）。85例存活住院患者中，17例未行PCI治疗或行强化CT检查，药物治疗后出院；19例行PCI，经影像学检查患者冠状动脉管腔内未发现血栓或血管闭塞，故未置入支架；46例患者行PCI检查发现患者血管管腔明显狭窄，置入支架扩张血管。溶栓治疗组中出现溶栓并发症者共3例，均为牙龈出血，未见消化道出血、颅内出血等并发症。结论 AMI患者CPR后静脉应用重组人尿激酶原溶栓治疗较未溶栓者预后良好，对于无开展PCI条件的医院，静脉溶栓仍是AMI心脏骤停患者CPR后的优选治疗方案。

关键词: 心肌梗死, 心肺复苏术, 尿激酶型纤溶酶原激活物, 临床研究

Abstract:

Background

In clinical practice, some primary hospitals lack the facilities to perform percutaneous coronary intervention (PCI). For patients with acute myocardial infarction (AMI), direct PCI is often challenging. Cardiopulmonary resuscitation (CPR) is considered a relative contraindication for thrombolytic therapy. Whether thrombolysis should be administered to AMI patients who experience cardiac arrest remains controversial.

Objective

To investigate the clinical efficacy, feasibility, and necessity of recombinant human pro-urokinase thrombolysis after CPR in AMI patients with cardiac arrest.

Methods

We retrospectively analyzed 117 patients with AMI and cardiac arrest who underwent CPR and were admitted to the emergency departments of the Second Hospital of Hebei Medical University, Ningjin County Hospital of Hebei Province, Xinle People's Hospital of Shijiazhuang, and Fengrun District People's Hospital of Tangshan from February 2015 to December 2021. Patients were divided into two groups based on the treatment received: the non-thrombolytic group (17 patients) and the thrombolytic group (100 patients). The non-thrombolytic group received comprehensive supportive treatment, including respiratory and circulatory support, anticoagulation, vasodilation, antiarrhythmia, and anti-shock therapies. The thrombolytic group received recombinant human pro-urokinase thrombolysis in addition to the treatments provided to the non-thrombolytic group. All thrombolytic treatments were administered within the therapeutic time window. Clinical data and outcomes were collected from the electronic medical record system and compared between the two groups.

Results

All 17 patients in the non-thrombolytic group died despite resuscitation efforts. In the thrombolytic group, 15 patients (15.0%) died, while 85 patients (85.0%) survived. Among the 85 surviving patients, 17 did not undergo PCI or were evaluated with enhanced CT scans and were discharged after medical treatment. Nineteen patients underwent PCI, and no thrombi or vascular occlusions were found in the coronary arteries on imaging, thus no stents were implanted. Forty-six patients underwent PCI and were found to have significant stenosis in the vascular lumen, requiring stent implantation to dilate the vessels. Three patients in the thrombolytic group experienced thrombolysis-related complications, all of which were gingival bleeding, with no gastrointestinal bleeding or intracranial hemorrhage observed.

Conclusion

Intravenous thrombolysis with recombinant human pro-urokinase after CPR in AMI patients with cardiac arrest is associated with better outcomes compared to non-thrombolytic treatment. For hospitals without PCI facilities, intravenous thrombolysis remains a preferred treatment option for AMI patients with cardiac arrest following CPR.

Key words: Myocardial infarction, Cardiopulmonary resuscitation, Urokinase-type plasminogen activator, Clinical research

黄晓韩,朱铁英,彭楠,等. 急性心肌梗死心脏骤停患者心肺复苏后重组人尿激酶原溶栓治疗效果研究[J]. 中国全科医学, 2025, 28(15): 1898-1902. DOI: 10.12114/j.issn.1007-9572.2023.0616.
HUANG Xiaohan,ZHU Tieying,PENG Nan, et al. Effect of Recombinant Human Prourokinase Thrombolytic Therapy on Acute Myocardial Infarction Patients with Cardiac Arrest after Cardiopulmonary Resuscitation[J]. Chinese General Practice, 2025, 28(15): 1898-1902. DOI: 10.12114/j.issn.1007-9572.2023.0616.

图/表 1

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分组	例数	性别（男/女）	年龄（岁）	基础疾病[例（%）]
分组	例数	性别（男/女）	年龄（岁）	高血压	冠心病	糖尿病	脑血管病	无基础疾病
溶栓治疗组	100	84/16	60.4±11.1	34（34.0）	23（23.0）	7（7.0）	0	42（42.0）
非溶栓治疗组	17	12/5	65.9±10.8	14（82.4）	9（52.9）	5（29.4）	2（11.7）	1（5.9）
t(χ²)值		-1.120^a	2.190	3.654^a	2.753^a	1.828^a	—	-4.694^a
P值		0.267	0.031	0.001	0.012	0.084	0.020	<0.001

分组	例数	性别（男/女）	年龄（岁）	基础疾病[例（%）]
分组	例数	性别（男/女）	年龄（岁）	高血压	冠心病	糖尿病	脑血管病	无基础疾病
溶栓治疗组	100	84/16	60.4±11.1	34（34.0）	23（23.0）	7（7.0）	0	42（42.0）
非溶栓治疗组	17	12/5	65.9±10.8	14（82.4）	9（52.9）	5（29.4）	2（11.7）	1（5.9）
t(χ²)值		-1.120^a	2.190	3.654^a	2.753^a	1.828^a	—	-4.694^a
P值		0.267	0.031	0.001	0.012	0.084	0.020	<0.001