Ventura B
Crit Care Nurs Clin North Am. 1990 Dec;2(4):663-71.
This past decade has seen remarkable progress in the use of thrombolytic agents to increase survival after AMI. Early IC strategies and several reperfusion trials of thrombolytic therapy visually demonstrated the efficacy of these agents. The life-saving benefits of thrombolysis have been illustrated by the large multicenter mortality trials with decreases in mortality from 15% to 8%. Mortality rates in AMI treated with rt-PA has been shown to be much lower in studies using full-dose IV heparin: TIMI IIB 4.9% (6 weeks), ASSET 7.2% (1 month), ECSG 3.7% (21 days). SK and APSAC are most effective at achieving thrombolysis when administered early in the course of AMI; rt-PA retains its superior efficacy on the older thrombus. When patients are properly screened for contraindications, IV-thrombolytic therapy is a safe and highly effective treatment for AMI. The choice of agent remains that of personal or institutional preference. Only when definitive results of ongoing and future head-to-head clinical trials are published can the effectiveness of the agents be compared accurately. Until these data are available, the most important lesson is to treat and treat quickly.
在过去十年中，溶栓药物在提高急性心肌梗死（AMI）后的生存率方面取得了显著进展。早期的冠状动脉内（IC）策略以及多项溶栓治疗的再灌注试验直观地证明了这些药物的疗效。大型多中心死亡率试验表明溶栓具有挽救生命的益处，死亡率从15%降至8%。在使用全剂量静脉肝素的研究中，rt-PA治疗的AMI死亡率已显示出低得多：TIMI IIB试验为4.9%（6周），ASSET试验为7.2%（1个月），ECSG试验为3.7%（21天）。链激酶（SK）和茴香酰化纤溶酶原链激酶激活剂复合物（APSAC）在AMI病程早期给药时最有效地实现溶栓；rt-PA对较老的血栓仍保持其卓越疗效。当对患者进行适当的禁忌症筛查时，静脉溶栓治疗是一种安全且高效的AMI治疗方法。药物的选择仍然取决于个人或机构的偏好。只有当正在进行的和未来的直接比较临床试验的最终结果发表时，才能准确比较这些药物的有效性。在获得这些数据之前，最重要的经验是尽快治疗。
