低分子肝素钙联合尿激酶静脉溶栓治疗心肌梗死的临床效果和安全性评价

Efficacy and safety evaluation of low molecular weight heparin calcium combined with urease on intravenous thrombolytic therapy for acute myocardial infarction

目的探讨低分子肝素钙联合尿激酶静脉溶栓治疗心肌梗死的临床效果，并评价该方法的安全性。方法在我院2011年1月至2012年12月收治的诊断为心肌梗死患者中随机选取107例，随机分为观察组（n=54）和对照组（n=53）。对照组给予一般治疗和基本的对症支持治疗；观察组患者在进行此治疗基础上静脉滴注尿激酶溶栓，皮下注射低分子肝素钙，10d为1疗程，观察两组患者的治疗效果，并评价观察组使用两种药物联合治疗的安全性。结果（1）观察组的冠状动脉再通率为83．33％（45／54），对照组的冠状动脉再通率为60．38％（32／53），观察组冠状动脉再通率显著优于对照组（x2=4．296，P〈0．05），差异有统计学意义。（2）观察组ST—T段回降50％所需要的时间为（2．0±0．6）h，再通时间（1．3±0．4）h；对照组ST-T段回降50％所需要的时间为（3．4±0．5）h，再通时间（2．1±0．3）h，观察组sT-T段回降50％所需要的时间以及再通时间明显短于对照组，差异均具有统计学意义（t值分别为2．948、3．186，P均〈0．05）。（3）观察组患者并发症发生率为44．44％（24／54），发生率明显低于对照组77．36％（41／53）（x2=3．918，P〈0．05），差异有统计学意义。观察组在进行常规治疗和低分子肝素联合尿激酶溶栓治疗过程中，出现再梗死的患者有2例，占3．70％；对照组在进行常规治疗中，出现再梗死的患者有9例，占16．98％；差异具有统计学意义（x2=4．142，P〈0．05）。结论低分子肝素联合尿激酶静脉溶栓治疗心肌梗死能显著提高患者的临床效果，该方案能降低并发症和再次心肌梗死的发生率，安全有效并可以明显改善患者的预后。

Objective To investigate the clinical effect of low molecular weight heparin calcium combined with urease on intravenous thrombolytic therapy for myocardial infarction, and evaluate its safety. Methods One hundred and seven patients diagnosed myocardial infarction were randomly divided into the observation group （ n = 54） and control group （ n = 53 ） , who were hospitalized in Yantai Central Hospital from January 2011 to December 2012. Patients in control group were given regular treatment plus basic support treatment for the symptomatic. Patients in the observation group were treated intravenous thrombolysis, subcutaneous low molecular weight heparin besides the basic treatment, 10 d as a course of treatment. Observed the therapeutic effect in patients, observed and evaluated the safety of using two drugs in combination therapy group . Results （ 1 ） The recanalization rate of coronary artery in observation group was 83.33% （45/54）, higher than that in the control group （60. 38% （32/53） ,X2 =4. 296;P 〈0. 05）. （2）The time of ST-T dropped back to 50% in the observation group was （2.0 ＋0.6） h,and recanalization time was （ 1.3 ＋0.4） h,less than that in the control group （3.4 ＋0. 5） h, （2. 1 ＋0. 3） h respectively） ,and the difference were significant （ t = 2. 948 ,P 〈 0. 05 ; t = 3. 186, P 〈 0.05 ）. （ 3 ） Incidence of complications in the observation group was 44.44% （24/54）, significantly less than that of the control group （ 77. 36% （ 41/53 ） ; X2 = 3. 918, P 〈 0.05 ） . Two cases of the observation group were with reinfarction, accounting for 3.70% and 9 cases in the control accounting for 16. 98%. The difference was statistically significance （ X2 = 4. 142 ; P 〈 0. 05 ）. Conclusion The therapy plan of low molecular heparin combined with urease intravenous thrombolytic therapy for myocardial infarction can significantly improve the clinical effect of patients, reduce the complications and the incidence of myocardial infarction. It was proved as a safe and effective therapy plan in improving the prognosis of patients.