溶栓治疗对急性心肌梗死患者凝血与纤溶系统的影响

Changes of coagulative and fibrinolytic parameters in the patients with acute myocardial infarction during thrombolytic therepy

目的：探讨急性心肌梗死（AMI）患者凝血及纤溶系统变化及其临床意义。方法：对51例AMI患者（37例溶栓治疗，14例未溶栓治疗）在治疗前，治疗后4h、12h、24h、48h、1周测定凝血酶原时间（PT）、活化的部分凝血活酶时间（APTT）、纤溶酶原（PCG）活性、α2抗纤溶酶（α2AP）活性、纤维蛋白原（Fg）含量、D二聚体（D-Dimer）含量。结果：AMI溶栓治疗后4h，PCG、α2AP活性及Fg含量大幅度降低，D－Dimer含量明显增高，PT、APTT明显延长；溶栓后48h各项指标已分别恢复至溶栓前水平。结论：溶栓治疗可使AMI患者凝血活性明显减弱，纤溶活性明显增强，但溶栓剂的作用时限短暂，监测PT、APTT、Fg等指标对预防出血有一定意义。

Objective:To explore the alterations of coagulative and fibrinolytic parameters with acute myocardial infarction (AMI). Methods: The patients were divided into routine treatment group (n=14)and thrombolytic therapy group (n=37). Prothrombin time (PT), actived partial thromboplasmin time (APTT), fibrinogen (Fg), D-Dimer, plasminogen (PLG ) and α2 antiplasmin (α2AP)activity were determined in all patients. Results:Plasme PLG activity,α2AP activity and Fg concentration were significantly decreased,D-Dimer concentration significantly increased. PT and APTT significantly prolonged in patients with thrombolytic therapy group. At 48 h after thrombolytic therapy,above parameters returned to the before treatment levels. Conclusion: After thrombolytic therapy,the fibrinolytic activity was significantly increased,coagulative activity was significantly decreased. During thrombolytic therapy,monitoring PT,APTT, Fg can play a role for preventing bleeding complication.