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目的：比较急性心肌梗死患者单纯静脉溶栓疗法和静脉溶栓加冠状动脉（冠脉）内溶栓疗法的疗效。方法：前法以（１５０～２００）×１０４Ｕ尿激酶进行静脉溶栓，后法以（１５０～２００）×１０４Ｕ尿激酶进行静脉溶栓后，再以（２０～５０）×１０４Ｕ尿激酶行冠脉内溶栓。结果：前法梗死相关动脉再通率为６０．０％；后法梗死相关动脉再通率为７６．９％。２组比较，χ２＝３．８６，Ｐ＜０．０５。住院病死率静脉溶栓组和静脉溶栓加冠脉内溶栓组分别为１２．５％和９．６％，２法比较存在显著性差异（χ２＝６．６６，Ｐ＜０．０１）。心功能１～２级者２组分别为９０．８％和９４．２％（χ２＝６．６４，Ｐ＜０．０１）；心功能３～４级者分别为９．２％和５．８％（χ２＝６．６５，Ｐ＜０．０１）。结论：冠脉内溶栓再通率高，在治疗的同时，还可了解梗死相关动脉再通和狭窄情况；静脉溶栓方法简便，可在发病早期实施。将两种方法相结合，缩短了等待溶栓的时间；静脉溶栓结合冠脉内溶栓优点，使血管再通率明显提高，并进一步降低了患者近期病死率。
Objective: To compare the efficacy of intravenous thrombolytic therapy and intravenous thrombolysis plus coronary thrombolysis in patients with acute myocardial infarction. Methods: The former method was intravenous thrombolysis with (150 ~ 200) × 104U urokinase, the latter was intravenously thrombolyzed with (150 ~ 200) × 104U urokinase, and then with (20 ~ 50) × 104U urokinase Intravenous thrombolysis. Results: The anterior infarction-related artery recanalization rate was 60.0%; the posterior infarction-related artery recanalization rate was 76.9%. 2 groups, χ2 = 3.86, P <0.05. In-hospital mortality was 12.5% in the thrombolytic group and 9.6% in the intravenous thrombolytic group and thrombolysis group. There was a significant difference between the two methods (χ2 = 6.66, P <0.01). Cardiac function grade 1 to 2 in 2 groups were 90.8% and 94.2% respectively (χ2 = 6.64, P <0.01); heart function grade 3 to 4 were 9.2% and 5 respectively. 8% (χ2 = 6.65, P <0.01). Conclusion: The rate of recanalization of coronary thrombolysis is high. At the same time of treatment, infarct-related recanalization and stenosis can be understood. Intravenous thrombolysis is simple and can be performed early in the disease. The combination of the two methods shortened the waiting time for thrombolysis; intravenous thrombolysis combined with the advantages of intra-coronary thrombolysis, the recanalization rate was significantly improved, and further reduce the patient’s recent mortality.