Figueredo V M, Amidon T M, Wolfe C L
Department of Cardiology, University of California San Francisco, School of Medicine.
Postgrad Med. 1994 Dec;96(8):30-4, 37-40.
Thrombolytic therapy has been proven to be highly effective and safe in patients presenting with acute myocardial infarction. Its use may reduce mortality rates by as much as 50%. Accelerated administration of tissue plasminogen activator (Activase) combined with intravenous heparin shows particular success in reducing mortality rates, especially in patients with anterior infarcts. However, strict compliance to the classic inclusion criteria has limited the number of patients, excluding several groups who have been shown to benefit from thrombolysis: The elderly appear to benefit from early thrombolysis even more than do their younger counterparts. Patients with inferior myocardial infarction and bundle-branch blocks also benefit. Recent trials suggest that thrombolytic therapy can be cautiously extended to patients presenting late (up to 24 hours) after onset of symptoms. Certain patients with a history of cerebrovascular disease or recent surgery, patients with severe hypertension, and those having undergone cardiopulmonary resuscitation should not necessarily be excluded from consideration.
溶栓治疗已被证明对急性心肌梗死患者非常有效且安全。其使用可将死亡率降低多达50%。加速给予组织纤溶酶原激活剂（阿替普酶）并联合静脉注射肝素在降低死亡率方面特别成功，尤其是在前壁梗死患者中。然而，严格遵守经典的纳入标准限制了患者数量，排除了几组已被证明可从溶栓治疗中获益的人群：老年人似乎比年轻人更能从早期溶栓中获益。下壁心肌梗死和束支传导阻滞的患者也能获益。最近的试验表明，溶栓治疗可谨慎地扩展至症状发作后较晚（长达24小时）就诊的患者。有脑血管疾病史或近期手术史的某些患者、严重高血压患者以及接受过心肺复苏的患者不一定应被排除在考虑之外。
