肝素抗凝治疗急性冠脉综合征的对比研究

Comparisons of Different Heparin Treatment for Acute Coronary Syndrome

目的观察不同抗凝方案治疗急性冠状动脉综合征（ACS）的疗效和安全性。方法入选对象为不稳定性心绞痛或非Q波心肌梗死患者，入选前48h以内至少有一次心绞痛发作，ST段无抬高。将120例入选病例随机分为静脉滴注普通肝素（UH）组和皮下注射低相对分子质量肝素（LMWH）组，UH组以UH240u／kg·d^-1分两次静脉滴注，连续10d，维持aPTT于60-85s或ACT于250-300s（正常值1．5-2．5倍）。LMWH组予LMWH5000μ，每日两次，皮下注射，连续10d。观察终点：随访治疗30d内发生急性心肌梗死、心脏性或非心脏性死亡和药物治疗无法控制的心绞痛需血运重建例数。住院治疗至少10d，随访至治疗后30d。结果两组用药期间平均胸痛发作次数差异无显著性，但肝素组有更多的患者需口服硝酸甘油缓解胸痛；死亡率、复合终点事件（死亡、心肌梗死和药物治疗无法控制的心绞痛）在LMWH组明显下降。LMWH组出血事件明显少于UH组。结论LMWH皮下注射与连续静脉滴注UH疗效相似，LMWH可明显减少急性冠状动脉综合征30d后死亡和复合心脏事件的发生，发生出血事件较少，应用更为方便安全。

Objective To observe the curative effects and safety.of different anticoagulant strategies on acute coronary syndrome（ACS）. Methods 120 patients with unstable angina pectoris（AP） or non-Q-wave myocardial infarction and AP episode for at least 1 time within 48 hours without elevated ST segments were involved and randomized into normal heparin group （n = 60, injected intravenously, with the heparin dose of 240 u/kg·d^-1, twicely and consecutively for 10 d. Meanwhile, the ACT or aFFF was monitored and kept 250 - 300 s in value of ACT or 60 - 85 s of aPTT ） and low molecular weight heparin group（ n = 60, received subcutaneous injection with 5000 u LMWH twicely for consecutive 10 d ）. Observations on those who turned out acute myocardial infarction within 30 d in the follow-up treatment or died cardiacally or non-cardiacally or uncontrollable AP were terminated. All subjects received hospitalization for no less than 10 d, with a follow- up treatment for 30 d. Results Insignificant differences in average frequency of chest pain were observed during the treatment. However, more cases applying nitroglycerine were demonstrated in heparin group, and an obvious decline in death rate and composite end point event was seen in LMWH group. Bleeding episode was apparently less in LMWH group than that of heparin group. Conclusion LMWH were reduces the incidence of death after ACS and composite cardiac events, with less bleeding complications than heparin, thus with more convenient and safer application.