Trombolitik tedavi ve olgularımız
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Date
2001
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Publisher
Uludağ Üniversitesi
Abstract
Trombolitik tedavi akut miyokard infarktüsünün standart tedavisi haline gelmiş olup hastalığın doğal seyrini hem kısa hem de uzun dönemde etkilemektedir. Trombolitik tedavi uygulamasındaki başlıca amaç plazminojeni plazmine çevirerek koroner damar tıkanmasına neden olan trombüsü erimektir. Bizde bu çalışmamı da trombolitik tedavi uyguladığımız yaşlan 28 ile 76 arasında değişen (ortalama 53 -10 yıl) 84'ü erkek ve 16'sı kadın toplam 100 olguyu inceledik. Olguların 92'sine streptokinaz (STK) ve 8'ine rekombinan doku plazminojen aktivatörü (rt-PA) uygulandı. Toplam 64 olguya koroner anjiyografi yapıldı. Trombolitik tedavi ile olgularda damar açıklı ı sağlanması % 61 iken, bu oran STK uygulananlarda% 64, rt-PA'da ise% 57 idi. Olgulanmıza göğüs ağrısı başladıktan sonra en erken yarım saat ve en geç 11 saat içinde trombolitik tedavi uyguladık (ortalama 3.10- 1.56 saat). İlk 6 saat içinde trombolitik tedavi uygulananlarda damar açıklığı sağlanması anlamlı olarak farklı idi (p< 0.0001). Trombolitik tedavi onrası semp omları gerileyen ve infarktüsün 24--48. saatinde tekrar ağrısı olan olgularımızda infarki damarının tıkalı olma olasılığı yüksektir (p<0.01). Trombolitik tedavi ile damar açıklığı sağlanmasında cinsiyet, sigara içimi, hipertansiyonun etkili olmadığını, öte yandan inferior miyokard infarktüsü, diyabetik olmayan ve obez olmayanlarda damar acıklı bağlamanın anlamlı olduğunu saptadık(p< 0.01). Trombolitik tedavi uyguladığımız 4 olgu kardiyojenik şoktan öldü. Olguların hiçbirisinde major bir kanama komplikasyonu gelişmedi. Sonuç olarak, trombolitik tedavi akut miyokard infarktüsünde gerek erken, gerekse geç dönemde prognoza etkilidir. Her hastaya uygun tedavi rejimi belirlenmeli ve fayda -zarar hesabı yapıldıktan sonra tedaviye başlanmalıdır.
Thrombolytic therapy is the main treatment in the acute myocardial infarction that affects the natural course of the disease at both early and late period The basic goal of the thrombolytic treatment is change plasminogen into plasmin that reso/ve thrombus in the occluded coronary artery. Our study included 100 patients (84 male, 16 female) between 28 and 76 years old (mean 53-1 0). We administered streptokinase (STK) to 92 patients, recombinant tissue plasminogen activator (rt-PA) to 8 patients. We performed coronary angiography on 64 patients. We achieved vessel patency with thrombolytic therapy 61 % of all patients, 64 %in the STK group, 57% in the rt-PA group. We performed thrombolytic treatment within the first half hour up to eleven hours (mean 3.1- 1.56 hours) after onset of chest pain. The vessel patency of thrombolytic treatment had a significant difference in the first six hours (p < 0.0001). In our cases whose symptoms regressed after thrombolytic treatment and who had chest pain within 24-48 hours during infarction, the probability of occlusion in the infarct related artery was high (p <0. 01). Achievement of vessel patency with thrombolytic treatment was not re/ated to gender, smoking, hypertension and it was related to inferior myocardial/ infarction, non- diabetes and non -obesity.F our patients died of cardiogenic shock. None of our patients had major bleeding complications. As a result, thrombolytic treatment was effective at both early and Late period during prognosis in myocardial infarction. For each patient, a suitable therapy must be established and treatment be instituted after benefit - risk ratio is taken into account.
Thrombolytic therapy is the main treatment in the acute myocardial infarction that affects the natural course of the disease at both early and late period The basic goal of the thrombolytic treatment is change plasminogen into plasmin that reso/ve thrombus in the occluded coronary artery. Our study included 100 patients (84 male, 16 female) between 28 and 76 years old (mean 53-1 0). We administered streptokinase (STK) to 92 patients, recombinant tissue plasminogen activator (rt-PA) to 8 patients. We performed coronary angiography on 64 patients. We achieved vessel patency with thrombolytic therapy 61 % of all patients, 64 %in the STK group, 57% in the rt-PA group. We performed thrombolytic treatment within the first half hour up to eleven hours (mean 3.1- 1.56 hours) after onset of chest pain. The vessel patency of thrombolytic treatment had a significant difference in the first six hours (p < 0.0001). In our cases whose symptoms regressed after thrombolytic treatment and who had chest pain within 24-48 hours during infarction, the probability of occlusion in the infarct related artery was high (p <0. 01). Achievement of vessel patency with thrombolytic treatment was not re/ated to gender, smoking, hypertension and it was related to inferior myocardial/ infarction, non- diabetes and non -obesity.F our patients died of cardiogenic shock. None of our patients had major bleeding complications. As a result, thrombolytic treatment was effective at both early and Late period during prognosis in myocardial infarction. For each patient, a suitable therapy must be established and treatment be instituted after benefit - risk ratio is taken into account.
Description
Keywords
Akut miyokard infarktüsü ve trombolitik tedavi, Streptokinaz, Rekombinan doku plazminojen aktivatörü, Acute myocardial infaretion and thrombolytic treatment, Streptokinase, Recombinant tissue plasminogen activator
Citation
Serdar, O. A. vd. (2001). ''Trombolitik tedavi ve olgularımız ''. Uludağ Üniversitesi Tıp Fakültesi Dergisi, 27(1-2-3), 1-5.