급성 심근경색증의 정맥 혈전용해요법에 대한 임상적 관찰 = Clinical Observation of Intravenous Thrombolytic Therapy in Acute Myocardial Infarction급성 심근경색증의 정맥 혈전용해요법에 대한 임상적 관찰

다국어 초록 (Multilingual Abstract)

Progress in reducing mortality and morbidity has been slow in spite of increased understanding of the pathophysiology af myocardial infarction. By the use of coronary care units together with improved therapy for life threatening arrhythmias, cardiac pump failure has emerged as the principal cause of in-hospital death. The objectives of thrombolytic therapy are to lyse coronary thrombi during the early phase of transmural myocardial infarction to salvage jeopardized myocardium, preserves ventricular function and may enhance survival by lysing thrombotic coronary artery occlusion which is commonest cause of transmural myocardial infarction. To evaluate the usefulness of thrombolytic agents (Urokinase : UK) for acute myocardial infarction, we analized 51 patiens who admitted within 6 hours after symptoms developed and treated with UK (0.3 million u bolus and daily 0.3 million u continuous IV infusion for 3-4 days) in case who did not have any evidence of contraindication of thrombolytic therapy and compared with 57 patients who were treated by conventional method. The results were as follows: 1) The annual cases of acute myocardial infarction showed increasing tendency and peak frequency of onset was from 6 a.m. to noon throughout the day. 2) The ratio of male to female for acute myocardial infarction was 3:1 and the average age was 59. 3) The common preceding disease were hypertension (31 cases), angina pectoris (21 cases) and diabetes mellitus (12 cases). The cholesterol level over 201 mg/dl was 40% of patients. 4) Anterior wall infarctions were observed in 59 cases, inferior wa11 infarctions in 46 ca and subendocardial infarctions were 3 cases. In anterior myocardial infarction, 20% and 29.4% expired with thrombolytic and conventional therapy respectively. In inferior myocardial infarction, 31.8% expired with conventional therapy but there was none with thrombolytic therapy, 5) Arrhythmias were observed in 83.6% of all cases and ventricular arrhythmia (60.2%) was the msot common. Conduction disturbances were observed in 24.1% and more frequent in inferior than anterior myocardial infarction. 6) Five of 51 patients (9.8%) were expired with thrombolytic therapy and 17 of 57 patients (29.8%) with conventional therapy were expired (P<0.01), and overall mortality was 20.4% 7) The mortality for killip classification III k IV was 38.5% and 66.7% with thrombolytic and conventional therapy respectively (P<0.1). The mortality who had Norris coronary prognostic index over 10 were 25% and 69.2% with thrombolytic and conventional therapy respectively (P <0.05). 8) Only one case of tarry stool was observed as a complication of thrombolytic therapy, In conclusion, intravenous thrombolytic therapy in early phase of acute myocardial infarction improved survival.