Alderman E L, Jutzy K R, Berte L E, Miller R G, Friedman J P, Creger W P, Eliastam M
Am J Cardiol. 1984 Jul 1;54(1):14-9. doi: 10.1016/0002-9149(84)90297-2.
The efficacy of intravenous (i.v.) thrombolytic therapy has not been firmly established in comparison with the intracoronary (i.c.) route of administration. In a randomized trial of 28 patients who underwent angiography before and during i.v. and i.c. administration of streptokinase (STK), recanalization was achieved in 73% of patients who received the drug by the i.c. route, compared with 62% of patients who received the drug by the i.v. route (difference not significant). Reopening took 28 minutes for i.c. STK and 39 minutes for i.v. STK. Patients in whom recanalization was successful using either route of administration had shorter euglobulin lysis times and lower fibrinogen levels than did patients in whom it was not successful (p less than 0.05). Bleeding complications were closely correlated with heparinization after thrombolysis rather than with STK itself. These results in a limited patient series suggest that early administration of i.v. STK in the emergency department may yield recanalization rates similar to those for the i.c. route and may benefit myocardial preservation by restoring flow much earlier.
与冠状动脉内（i.c.）给药途径相比，静脉内（i.v.）溶栓治疗的疗效尚未得到确切证实。在一项对28例患者进行的随机试验中，这些患者在静脉内和冠状动脉内给予链激酶（STK）之前和期间均接受了血管造影，通过冠状动脉内途径接受药物治疗的患者中有73%实现了再通，而通过静脉内途径接受药物治疗的患者中这一比例为62%（差异无统计学意义）。冠状动脉内给予STK再通用时28分钟，静脉内给予STK再通用时39分钟。无论采用哪种给药途径成功实现再通的患者，其优球蛋白溶解时间均短于未成功实现再通的患者，纤维蛋白原水平也低于未成功实现再通的患者（p<0.05）。出血并发症与溶栓后肝素化密切相关，而非与STK本身相关。这些在有限患者系列中的结果表明，在急诊科早期给予静脉内STK可能产生与冠状动脉内途径相似的再通率，并且可能通过更早恢复血流而有益于心肌保护。
