目的 探讨生脉注射液联合阿替普酶治疗急性心肌梗死的临床疗效。方法 选取2013年3月-2015年3月在石家庄市第二医院急诊科接受治疗的急性心肌梗死患者92例,按照治疗方法的不同分为对照组和治疗组,每组各46例。对照组给予注射用阿替普酶,100mg在90min内滴完,首先给予15mg静脉推注,随后在30min内静脉滴注50mg,最后35mg在60min内滴完,1次/d。治疗组在对照组治疗的基础上静脉滴注生脉注射液,60mL加入生理盐水250mL,1次/d。两组患者均连续治疗14d。观察两组的临床疗效和冠状动脉再通情况,同时比较治疗前后炎症因子包括血浆脑钠肽(BNP)、肿瘤坏死因子α(TNF-α)、白细胞介素6(IL-6)及高敏C反应蛋白(hs-CRP),血液流变学指标包括血细胞比容(HCT)、红细胞聚集指数(RF)、全血高切黏度(HS)、纤维蛋白原(FIB)等指标的变化情况。结果 治疗后,对照组和治疗组的总有效率分别为80.43%、95.65%,冠脉再通率分别为65.22%、84.78%,两组比较差异具有统计学意义(P<0.05)。治疗后,两组患者IL-6、BNP、TNF-α、hs-CRP、HCT、FIB、RF、HS均显著降低,同组治疗前后差异具有统计学意义(P<0.05);且治疗组这些观察指标的改善程度优于对照组,两组比较差异有统计学意义(P<0.05)。结论 生脉注射液联合阿替普酶治疗急性心肌梗死具有较好的临床疗效,可明显减轻炎性反应,有利于改善血流动力学,具有一定的临床推广应用价值。

Objective To investigate the clinical effect of Shengmai Injection combined with alteplase in treatment of acute myocardial infarction. Methods Patients (92 cases) with acute myocardial infarction in Department of Emergency of the Second Hospital of Shijiazhuang from March 2013 to March 2015 were enrolled in this study. According to the different treatment plans, patients were divided into control group (46 cases) and treatment group (46 cases). The patients in the control group were given Alteplase for injection, dropped down 100 mg in 90 min. First they were iv administered with Alteplase for injection 15 mg, then intravenous drip 50 mg within 30 min, the last 35 mg drops down in 60 min, once daily. The patients in the treatment group were iv administered with Shengmai Injection on the basis of the control group, 60 mL added into normal saline 250 mL, once daily. The patients in two groups were treated for 14 d. After treatment, the clinical efficacies and coronary artery recanalization were evaluated, and the changes of BNP, TNF-α, IL-6, hs-CRP, HCT, RF, HS, and FIB in two groups were compared before and after treatment. Results After treatment, the efficacies in the control and treatment groups were 80.43% and 95.65%, and the rate of coronary artery recanalization in two groups were 65.22% and 84.78%, respectively, and there were differences between two groups (P < 0.05). After treatment, IL-6, BNP, TNF-α, hs-CRP, HCT, FIB, RF, and HS in two groups were significantly decreased, and the difference was statistically significant in the same group (P < 0.05). After treatment, the observational indexes in the treatment group were significantly better than those in the control group, with significant difference between two groups (P < 0.05). Conclusion Shengmai Injection combined with alteplase has clinical curative effect in treatment of acute myocardial infarction, and can significantly reduce inflammatory reaction, also can improve blood flow dynamics, which has a certain clinical application value.