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低分子肝素在阿替普酶溶栓治疗中的应用 被引量:4

Clinical Study of Low Molecular Weight Heparin Combined with Alteplase for Thrombolysis
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摘要 目的探讨急性心肌梗死(acute myocardial infarction,AMI)低分子肝素在阿替普酶(Alteplase,rt-PA)溶栓治疗的应用,并与溶栓治疗中传统抗凝药物普通肝素相比较.方法选取AMI患者35例,其中研究组15例,对照组20例,均给予阿替普酶静脉溶栓治疗;研究组溶栓前即刻静脉注射依诺肝素素30 mg,溶栓后15 min皮下注射依诺肝素40 mg,以后每12 h皮下注射依诺肝素40 mg,共5 d;对照组:溶栓前即刻静脉注射普通肝素4 000 U(或60 U/kg),后以800-1 000 U/h静脉泵入普通肝素,依据部分凝血活酶时间(APTT值)调整肝素用量,每3 h测一次凝血常规,使APTT维持于正常对照的1.5-2.0倍(50-70 s),48 h后改为皮下注射依诺肝素每12 h 40 mg,共5 d.所有患者均给予指南推荐的常规治疗.结果研究组达到临床再通及冠脉再通标准为86.66%,再通时间平均(1.62±0.36)h;对照组为65.00%,再通时间(1.81±0.33)h.2组再通率及再通时间比较差异无统计学意义(P〉0.05).出血并发症研究组1例(6.66%),对照组5例(25%),2组均未出现颅内出血等严重或致命性出血.结论急性心肌梗死使用阿替普酶溶栓治疗中抗凝药物选用低分子肝素疗效不低于传统普通肝素,但方法简便、操作简化,不必反复监测凝血指标,减轻了临床工作负担,优化了溶栓流程,适合向基层及急救系统推广应用. Objective The aim of this study was to investigate the application of low molecular weight heparin combined with alteplase for thrombolysis in patients with acute myocardial infarction(AMI),and to compare its thrombolysis effect with traditional anticoagulant-general heparin. Methods 35 AMI patients with alteplase intravenous thrombolytic therapy were divided into two groups,among which 15 cases in the study group were treated with 30 mg enoxaparin instant intravenous injection before thrombolysis,40 mg enoxaparin hypodermic injection 15 minutes after thrombolysis,40 mg enoxaparin hypodermic injection every 12 hours for 5 days. The other 20 cases were assigned to the control group and treated with 4 000 u(or 60 u/kg) general heparin instant intravenous injection, then pumped general heparin intravenously in the rate of 800-1 000 u/h. Meanwhile, detected coagulation convention every 3 hours and adjusted the dose of heparin according to the activated partial thromboplastin time(APTT) to keep APTT value within 1.5 to 2.0 times(50-70 s) the standard value. 48 hours later, patients in the control group was given hypodermic injection of 40 mg enoxaparin every 12 hours for 5 days.All cases were given regular treatment as guidelines recommended. Results The patency rate of infarct-related coronary artery assessed by unified clinical criteria was 86.66% and 65.00%, and the average recanalization time was(1.62±0.36) h and(1.81±0.33) h in the study and control groups, respectively. There were no significant differences on patency rate and recanalization time between the two groups(P〉0.05). One case of bleeding complication occurred in the study group(6.66%),while five cases occurred in the control group(25.00%). In the two groups,no cases appeared intracranial hemorrhage and other serious or fatal bleeding occurred. Conclusion The clinical efficacy of low molecular weight heparin was non-inferior to general heparin in AMI patients with alteplas thrombolysis. The application of low molecular weight heparin was simple and easy to operate. It can optimize the procedure of thrombolysis,reduce repetitive coagulation index monitoring and lessen clinical workload,which is worth being promoted to primary hospital and the emergency systems.
出处 《昆明医科大学学报》 CAS 2016年第5期93-96,共4页 Journal of Kunming Medical University
基金 云南省自然科学基金资助项目(2013FZ258)
关键词 急性心肌梗死 低分子肝素 静脉溶栓疗法 Acute myocardial infarction Low molecular weight heparin Intravenous thrombolytic therapy
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  • 1无.急性ST段抬高型心肌梗死诊断和治疗指南[J].中华心血管病杂志,2010,38(8):675-690. 被引量:1978
  • 2陈灏珠.实用内科学[M].第12版.北京:人民卫生出版社,2006.1895-1896.
  • 3TJANDRAWIDJAJA M C,FU Y,WESTERHOUT C,et al. Resolution of ST-segment depression:a new prognostic marker in ST-segment elevation myocardial infarction [ J ]. Eur Heart J, 2010,31(5):573-581.
  • 4赵昕,韩雅玲,王效增,徐白鸽,王颐玲,邓婕.磺达肝癸钠对急性心肌梗死阿替普酶溶栓的疗效及安全性研究[J].中国实用内科杂志,2013,33(10):812-815. 被引量:10
  • 5STEG P G,JAMES S K,ATAR D,et al.ESC guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation [J]. Eur Heart J, 2012,33(20) :2569-2619.
  • 6OGARA P T,KUSHNER F G,ASCHEIM D D,et al.2013 ACCF/AHA guideline for the management of ST-elevation myocardial infarction:a report of the American College ofCardiology Foundation/American Heart Association Task Force on Practice Guidelines [ J ]. Cireulation, 2013,127 (4) : e362- e425.
  • 7WINDECKER S,KOLH P,ALFONSO F,et al.2014 ESC/EACTS Guidelines on myocardial revascularization:the Task Force on Myocardial Revascularization of the European Society of Cardiology (ESC)and the European Association for Cardio-Thoracic Surgery (EACTS) developed with the spe cial contribution of the European Association of Percuta- neous Cardiovascular Interventions (EAPCI) [J]. Eur Heart J,2014,35(37) : 2541-2619.
  • 8VAN DE WERF F, BAX J, BETRIU A, et al.Management of acute myocardial infarction in patients presenting with per- sistent ST-segment elevation:the Task Force on the Man- agement of ST-segment Elevation Acute Myocardial Infarc- tion of the European Society of Cardiology [ J ]. Eur Heart J, 2008,29 (23) : 2909- 2945.
  • 9PINTO D S,FREDERICK P D,CHAKRABARTI A K,et al.Benefit of transferring ST-segment-elevation myocardial infarction patients for percutaneous coronary intervention compared with administration of onsite fibrinolytic declines as delays increase [J]. Circulation,2011,124 (23): 2512-2521.
  • 10HAN Y L,LIU J N,JING Q M,et al. The efficacy and safety of pharmacoinvasive therapy with prourokinase for a- cute ST-segment elevation myocardial infarction patients with expected long percutaneous coronary intervention-re- lated delay [ J ]. Cardiovasc Ther, 2013,31 (5):285- 290.

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