应用低分子肝素对梗死相关血管开通率及维持的影响

The Effect of Fragmin on Early Reperfusion and Maintainance of Infarct Related Coronary Blood Flow

目的评价溶栓前后应用低分子肝素（法安明）对梗死相关血管开通率及维持的影响。方法将符合溶栓标准的８３例患者分成法安明组（４２例）和对照组（４１例），法安明组溶栓前给予法安明静注，并在溶栓后 １２ ｈ皮下注射，５０００ Ｕ，每天 ２次，应用 ２周。对照组溶栓后 １２ ｈ皮下给予肝素钙 ７５００ Ｕ，每天 ２次，应用 ２周。观察两组 ９０ ｍｉｎ造影 ＴＩＭＩ３级血流情况及住院期间心脏事件及出血发生率。结果 ９０ ｍｉｎ造影梗死相关血管 ＴＩＭ１３级血流法安明组 ５０％，对照组 ３６． ５％（Ｐ＞０． ０５），住院期间心脏事件、出血发生率法安明组分别为 １４． ３０， ９． ５％，均明显低于对照组 ３９． ０％和 ２９． ２％（ Ｐ＜ ０． ０５）。结论溶栓前后应用低分子肝素有助于提高和维持梗死相关血管再通率。

Objective: To evaluate the effect of low molecular weight heparin (Fragmin ) as an adjuvant treatment of thrombolysis in acute myocardial infarction regarding early reperfusion, cardiac event and bleeding complication during hospitalization. Methods: 83 patients with acute myocardial infarction were divided into 2 groups (fragmin group and control group). Fragmin was given with an intervenous bolus of 5000 IU prior to thrombolysis and followed up as a subcutaneous injection of 7500 IU every 12 h for 14 days in fragmin group. Un fractioned heparin was administrated as a a subcutaneous injection of 5000 IU every 12 h for 14 days incontrol group. Coronary angiography was performed 90 min to evaluate TIMI - flow in the infarct - related artery. Cardiac event and bleeding complication were also analysed in these patients during hospitalization. Results: The patent rate of infarct - related artery during 90 min angiogram was 50 % in fragmin group and 36. 5 % in control group (P >0. 05). During hospitalization,cardiac event and bleeding complication was 14. 3 % and 9. 5 % in fragmin group, 39. 0 % and 26. 2 % in control group (P <0. 05). Conclusion: how molecular weight heparin (fragmin) may improve early reper fusion and maintainace of coronary blood flow with an intravenous bolus injection prior to thrombolysis.