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[摘要]
目的 研究注射用瑞替普酶联合还原型谷胱甘肽治疗急性ST段抬高型心肌梗死的效果及安全性。方法 选取2015年2月-2016年2月于湖北监利县人民医院接受治疗的急性ST段抬高型心肌梗死患者90例,按照不同的治疗方式分为A、B、C组,A组患者给予常规治疗,B组患者在常规治疗的基础上给予还原型谷胱甘肽治疗,C组患者在常规治疗的基础上给予注射用瑞替普酶联合还原型谷胱甘肽治疗,比较3组患者的血管再通率;疗效相关指标,包括肌酸激酶同工酶(CKMB)、肌钙蛋白I(cTnI)、左心室舒张末期内径(LVEDd)及左室射血分数(LVEF);氧化应激相关酶,包括超氧物歧化酶(SOD)和谷胱甘肽过氧物酶(GSH-Px);不良反应,包括出血、再梗死、心绞痛、心律失常等。结果 C组患者首次治疗后2、6、12 h血管再通率较A、B组显著提高(P<0.05);与治疗前比较,3组患者治疗后疗效相关指标均得到明显改善(P<0.05);治疗后组间比较,C组各项指标改善均优于A、B组,差异显著(P<0.05)。B、C组患者治疗后,SOD及GSH-Px均较治疗前显著升高(P<0.05),B、C组间无明显差异。C组不良反应发生情况明显少于A、B组,差异显著(P<0.05)。结论 注射用瑞替普酶联合还原型谷胱甘肽治疗急性ST段抬高型心肌梗死能有效改善心功能,提高血管再通率,抑制氧化应激反应,减少不良反应发生,临床上值得推广。
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[Abstract]
Objective To research the effect and safety of Reteplase for Injection combined with reduced glutathione in the treatment of acute ST segment elevation myocardial infarction. Methods Patients with acute ST segment elevation myocardial infarction (90 cases) in Jianli People's Hospital from February 2015 to February 2016 were selected and divided equally into A, B and C groups according to different treatment methods. Totally 30 patients in group A were given conventional therapy, 30 patients in group B were given reduced glutathione for treatment on the basis of conventional treatment, and the other 30 in group C were given combined therapy of reteplase and reduced glutathione on the basis of conventional treatment. The vascular recanalization rate, improvement of effective indicators including creatine kinase isoenzyme (CKMB), troponin I (cTnI), left ventricular end diastolic diameter (LVEDd) and left ventricular ejection fraction (LVEF), oxidative stress kinase including superoxide dismutase (SOD) and glutathione peroxidase (GSH-Px), and incidence of adverse events of patients were compared among the three groups. Results After thrombolysis, the vascular recanalization rate of group C at different time points (2 h, 6 h and 12 h) showed significant difference compared with those of groups A and B (P<0.05). After the treatment, the effective indicators of the three groups were both significantly improved (P<0.05), and group C improved more significantly than groups A and B (P<0.05). After the treatment, the SOD and GSH-Px of groups B and C both significantly improved than group A (P<0.05), but there was no significant difference between groups B and C. After treatment, the incidence of adverse events of group C was significantly lower than those of groups A and B (P<0.05). Conclusion Reteplase for Injection combined with reduced glutathione has significant curative effect in the treatment of acute ST segment elevation myocardial infarction, which can effectively improve the cardiac function and inhibition of oxidative stress. It is of higher security but with lower incidence of adverse events.
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