急性心肌梗塞患者早期应用低分子肝素钙对溶栓疗效的影响

Effectiveness of early use of low molecular-weight heparin calcium for thrombolytic therapy in patients with acute myocardial infarction

目的:探讨早期应用低分子肝素钙(LMWH)对急性心肌梗塞患者溶栓疗效的影响。方法:第一组(43例,溶栓前应用LMWH+尿激酶组):入院后立即腹壁皮下注射LMWH5000IU,抗凝后平均(40±20)min使用尿激酶150万U溶栓。第二组(45例,尿激酶+溶栓后2h应用LMWH组):入院后(40±20)min使用尿激酶150万U溶栓,溶栓后2h应用LMWH5000IU腹壁皮下注射。第三组(42例,常规尿激酶溶栓组),常规溶栓后6h应用LMWH5000IU腹壁皮下注射。冠状动脉再通标准为同时具备1996年7月太原会议参考方案中间接指征的2项或2项以上。结果:第一组43例中37例再通(再通率83.7%)。第二组45例中再通35例(77.78%)。第三组42例中再通24例(57.14%)。第一组和第二组血管再通率差异无显著性(P>0.05),第一组与第三组血管再通率差异有极显著意义(P<0.01);第二组与第三组血管再通率差异有显著意义(P<0.05)。结论:早期应用低分子肝素抗凝可提高急性心肌梗塞患者的溶栓成功率。

Objective： To evaluate the effectiveness of early use of low molecular-weight heparin （LMWH） calcium for thrombolytic therapy in patients with acute myocardial infarcfion （AMI）. Methods： The 43 patients in group 1 were injected 5000 U LMWH before thrombolyfic therapy and then received 1.5 million U urokinase after 20～60 min. The 45 patients in group 2 received 1.5 million U urokinase for thrombolydc therapy and then were injected 5000 U LMWH after 2 h. The 42 patients in group 3 were injected 5000 U LMWH after normal thrombolytic the apy 6 h later. The standard of re-vascuiarization for coronary artery was in accordance with two or more items of the reference draft drawn up in Taiyuan conference in 1996. Results： The 37 of the 43 eases （83.7%） in group 1 achieved re-vaseularization. The 35 of the 45 cases （77.8%） in group 2 achieved re-vaseularization. Only 24 of the 42 cases （57.14%） in group 3 achieved re-vaseularization. The rate of re-vaseularization between group 1 and 2 showed no statistical difference （P〉0.05） while the difference between group 1 and 3 was very significant （P〈0.01）, and the difference between group 2 and 3 was also significant （P〈0.05）. Conclusion： The early use of low molecular-weight heparin calcium for thrombolytie therapy in patients with acute myocardial infarction improves the cure rate.