相对小分子质量肝素在左心导管术中的应用

Low molecular weight heparin for left cardiac catherterization

目的:比较相对小分子质量肝素(LMWH)和普通肝素(UFH)预防左心导管术中血栓形成和出血并发症的发生率.方法:行左心导管术426例接导管号随机分成两组,分别于动脉鞘管内给予LMWH或UFH,LMWH按95IU/kg.UFH按50IU/kg体重给药.观察术中及术后血栓、出血现象的发生率.部分病人动态检测出、凝血时间及部分凝血活酶时间.结果:LMWH组与UFH组对比,总的全身出血现象发生率明显减少,分别为6.4%和24.5%,平均术后压迫止血时间明显缩短,分别为(10.2±16.2)和(28.4±20.1)min,用药1h后两组部分凝血活酶时间均较正常延长,4h UFH组离均差较大,提示各例间差异较大.4h UFH组仍延长,而LMWH组恢复正常.两组均无一例出现血栓栓塞.结论:LMWH组在左心导管术预防血栓并发症的有效性与UFH组相仿.但比UFH更安全.

AIM : To compare the efficacy and safety of low molecular weight heparin (LMWH) (fraxiparine) with unfractionated heparin (UFH) and to recognize the value of a single dose of LMWH for left cardiac catherterization; METHODS: Four hundred and twen-ty-six patients were divided into 2 groups in randomized fashion and given with LMWHs (95 IU/kg) or UFH (50 IU/kg); left cardiac catherterization performed by Judkin's method. Bleeding time, coagulation time and activated partial thromboplastin time were measured in a part of patients. Statistics: the figures between groups by t test and comparison of rates by X2 test; RESULTS: A significant decrease of the total bleeding and occult bleeding was seen in the LMWH. There was sigificantly shortened in the presure time at the puncture sited in the LMWH. APTT was prolongated in the 2 groups (but it is more divergent in the UFH) at 1 h, and basically returned to pre-levels in the LMWH by 4 h, whereas still markedly pro-longated in the UFH(P<0. 01). No major thombembolia was encountered with either group. CONCLUSION: It is both effective in left cardiac catherterization by injecting UFH and LMWH for prevention of thombembolia complication, and more safe by LMWH.