低分子肝素预防经皮腔内冠状动脉成形术后急性闭塞临床分析

Clinical study of low-molecular weight heparin on the prevention of acute closure after percutaneous intracavitary coronary angioplasty

目的 研究低分子肝素对经皮腔内冠状动脉成形术 (PTCA)后急性闭塞的预防作用及其临床特点。方法 73例患者随机分为低分子肝素 (LMWH)组与普通肝素 (SH)组 ,观察两组 2 4小时内临床疗效、并发症发生率 ,并用单光子发射型计算机断层心肌灌注显像 (SPECT)和冠状动脉造影 (CAG)检查判断靶血管血流情况。结果 LMWH组无一例出现出血并发症。 3例术后 2 4小时内心绞痛再发并经 CAG证实为靶血管性闭塞 (8.6 % )。SH组 2例手术后 7小时出现牙龈及皮下出血 ,2例于术后 12小时出现血尿 ,1例因脑出血死亡 (经 CT证实 ) (出血总发生率 13.2 % )。4例术后 2 4小时内心绞痛再发并经 CAG证实为靶血管急性闭塞 (10 .5 % )。两组比较出血并发症有显著差异 (P<0 .0 5 ) ,急性闭塞发生率无显著差异 (P>0 .0 5 )。结论 L MWH具有与 SH相同的预防 PTCA术后急性冠脉闭塞作用 ,且能明显减少出血并发症 ,是一种安全可靠的预防 PTCA术后急性冠脉闭塞的药物。

Objective To evaluate the safety and efficacy of low-molecular weight heparin on the prevention of acute closure after percutaneous intracavitary coronary angioplasty.Methods 73 patients were randomly assigned to LMWH and SH groups.All patients underwent SPECT or CAG.Myocardial ischemia and hemorrhage complication were analyzed.Results In Group LMWH,no case of hemorrhage complication occurred,and in 3 cases angina occurred within 24h after the operation,which was proved by CAG to be acute closure of target vessel (the incidence rate 8.6%) .In Group SH,gum and subcutaneous hemorrhage occurred to 2 cases within 7h after the operation,hematuria occurred to 2 cases within 12h and one case died from cerebral hemorrhage,which was confirmed by CT (the total hemorrhage incidence 13.2%).Another 4 cases in Group SH suffered from re-occurrence of angina,which was confirmed by CAG to be acute closure of target vessel (10.5%).There was significant difference in hemorrhage complication between the two groups (P<0.05),while the occurrence of acute closure showed no significant difference (P>0.05)。Conclusion The results suggest that LMWH is safe and effective in the prevention of acute closure after native vessel coronary angioplasty.