目的 研究注射用瑞替普酶聯合還原型谷胱甘肽治療急性ST段抬高型心肌梗死的效果及安全性。方法 選取2015年2月-2016年2月于湖北監(jiān)利縣人民醫(yī)院接受治療的急性ST段抬高型心肌梗死患者90例，按照不同的治療方式分為A、B、C組，A組患者給予常規(guī)治療，B組患者在常規(guī)治療的基礎上給予還原型谷胱甘肽治療，C組患者在常規(guī)治療的基礎上給予注射用瑞替普酶聯合還原型谷胱甘肽治療，比較3組患者的血管再通率；療效相關指標，包括肌酸激酶同工酶（CKMB）、肌鈣蛋白I（cTnI）、左心室舒張末期內徑（LVEDd）及左室射血分數（LVEF）；氧化應激相關酶，包括超氧物歧化酶（SOD）和谷胱甘肽過氧物酶（GSH-Px）；不良反應，包括出血、再梗死、心絞痛、心律失常等。結果 C組患者首次治療后2、6、12 h血管再通率較A、B組顯著提高（P<0.05）；與治療前比較，3組患者治療后療效相關指標均得到明顯改善（P<0.05）；治療后組間比較，C組各項指標改善均優(yōu)于A、B組，差異顯著（P<0.05）。B、C組患者治療后，SOD及GSH-Px均較治療前顯著升高（P<0.05），B、C組間無明顯差異。C組不良反應發(fā)生情況明顯少于A、B組，差異顯著（P<0.05）。結論 注射用瑞替普酶聯合還原型谷胱甘肽治療急性ST段抬高型心肌梗死能有效改善心功能，提高血管再通率，抑制氧化應激反應，減少不良反應發(fā)生，臨床上值得推廣。

Objective To research the effect and safety of Reteplase for Injection combined with reduced glutathione in the treatment of acute ST segment elevation myocardial infarction. Methods Patients with acute ST segment elevation myocardial infarction (90 cases) in Jianli People's Hospital from February 2015 to February 2016 were selected and divided equally into A, B and C groups according to different treatment methods. Totally 30 patients in group A were given conventional therapy, 30 patients in group B were given reduced glutathione for treatment on the basis of conventional treatment, and the other 30 in group C were given combined therapy of reteplase and reduced glutathione on the basis of conventional treatment. The vascular recanalization rate, improvement of effective indicators including creatine kinase isoenzyme (CKMB), troponin I (cTnI), left ventricular end diastolic diameter (LVEDd) and left ventricular ejection fraction (LVEF), oxidative stress kinase including superoxide dismutase (SOD) and glutathione peroxidase (GSH-Px), and incidence of adverse events of patients were compared among the three groups. Results After thrombolysis, the vascular recanalization rate of group C at different time points (2 h, 6 h and 12 h) showed significant difference compared with those of groups A and B (P<0.05). After the treatment, the effective indicators of the three groups were both significantly improved (P<0.05), and group C improved more significantly than groups A and B (P<0.05). After the treatment, the SOD and GSH-Px of groups B and C both significantly improved than group A (P<0.05), but there was no significant difference between groups B and C. After treatment, the incidence of adverse events of group C was significantly lower than those of groups A and B (P<0.05). Conclusion Reteplase for Injection combined with reduced glutathione has significant curative effect in the treatment of acute ST segment elevation myocardial infarction, which can effectively improve the cardiac function and inhibition of oxidative stress. It is of higher security but with lower incidence of adverse events.