急性心肌梗死静脉尿激酶溶栓后早期应用肝素防止再梗死的临床研究

Clinical study on early applying Heparin on preventing re-infarction after intravenous Urokinase thrombolysis of acute myocardial infarction

目的:观察急性心肌梗死静脉尿激酶溶栓后早期应用肝素防止再梗死的临床效果。方法:将104例急性心肌梗死溶栓患者随机分为观察组和对照组,各52例。对照组予以尿激酶;观察组在应用尿激酶前即刻给予肝素5 000 U静脉注射,并于尿激酶给药12 h后监测凝血时间和(或)激活全血凝固时间(ACT),待与治疗前比较其<1.5倍时,予以肝素皮下注射。结果:观察组再通率为86.54%,对照组再通率为69.23%,两组比较,差异有统计学意义(P<0.05);观察组血管再通后再梗死率为4.44%,对照组血管再通后再梗死率为19.44%,两组比较,差异有统计学意义(P<0.05);两组治疗后血清肌酸激酶同工酶水平比较,两组升高趋势比较,观察组明显优于对照组,差异有统计学意义(P<0.01)。结论:急性心肌梗死静脉尿激酶溶栓后早期应用肝素能够防止血管再闭塞,减少再梗死率,联合用药具有安全、简便、易行的优点。

Objective：To observe the clinical effect of early applying Heparin on preventing further infarction after intravenous Urokinase thrombolysis of acute myocardial infarction.Methods：104 patients with acute myocardial infarction were randomly divided into two groups of 52 cases in observation group and 52 cases in control group respectively.The control group was given with Urokinase;the observation group was immediately given with Heparin 5 000 U intravenous injection before applying Urokinase,the clotting time and activation whole blood clotting time（ACT） were monitored 12 hours after Urokinase was given,and subcutaneous Heparin was injected when it was compared with that before treatment for 1.5 times.Results：In the observation group recanalization rate was 86.54%,the control group was 69.23%,the comparison difference of the two groups was statistically significant（P0.05）;the infarction rate of the observation group after recanalization was 4.44%,the infarction rate of the control group after recanalization was 19.44%,the comparison difference of the two groups was statistically significant（P0.05）;the serum creatine kinase isoenzyme levels of the two groups after treatment were compared,the increasing trends of the two groups were compared,the observation group was better than that of the control group,and the difference was statistically significant（P0.01）.Conclusion：The early application of Heparin on preventing further infarction after intravenous urokinase thrombolysis of acute myocardial infarction can prevent blood vessel from re-infarction and reduce the reinfarction rate,and combination drug application has the advantages of safety,convenience and feasibility.