White H D
Department of Coronary Care and Cardiovascular Research, Green Lane Hospital, Auckland, New Zealand.
Cardiol Clin. 1995 Aug;13(3):347-54.
Streptokinase remains the most widely used agent worldwide, largely because it is the cheapest. Because of cost considerations when the incremental cost of the use of accelerated TPA exceeds $35,000 (US) per life year added, and because an iatrogenically induced stroke in a patient who is otherwise likely to have a good outcome is unacceptable, streptokinase may be used in patients with small to moderate-sized infarctions and those aged less than 60 years. Streptokinase is the agent of choice in patients who have an increased risk of stroke and may be used in patients presenting after 6 hours. Streptokinase also may have a role in patients with cardiogenic shock. Administration of accelerated TPA is the treatment of choice in patients at high risk such as those with large anterior infarctions, the elderly, and patients with bypass grafts, and it is an alternative to urokinase when streptokinase has been administered previously. The most important approach is to treat as many patients as early as possible with thrombolytic therapy regardless of which agent is used. Thrombolytic therapy still is widely underused. More lives will be saved, regardless of which thrombolytic drug is used, by encouraging patients to present early, improving on the "door-to-needle" time, and treating more patients with a therapy that can save thousands of lives worldwide.
链激酶仍是全球使用最广泛的药物，主要原因是它最为便宜。出于成本考虑，当使用加速型组织型纤溶酶原激活剂（TPA）的增量成本超过每增加一个生命年35,000美元（美国）时，并且由于在原本可能预后良好的患者中发生医源性中风是不可接受的，链激酶可用于小到中度梗死的患者以及年龄小于60岁的患者。链激酶是中风风险增加患者的首选药物，也可用于发病6小时后就诊的患者。链激酶在心源休克患者中也可能有作用。对于高危患者，如大面积前壁梗死患者、老年患者和接受搭桥手术的患者，加速型TPA给药是首选治疗方法，并且当先前已使用链激酶时，它是尿激酶的替代药物。最重要的方法是尽早用溶栓疗法治疗尽可能多的患者，而不管使用哪种药物。溶栓疗法仍广泛未得到充分利用。通过鼓励患者尽早就诊、缩短“门到针”时间，并采用一种能在全球挽救数千生命的疗法治疗更多患者，无论使用哪种溶栓药物，都会挽救更多生命。
