肝素联合阿替普酶静脉溶栓治疗急性ST段抬高型心肌梗死的效果

Thrombolytic effect of Alteplase combined with Heparin in treatment of acute ST segment elevation myocardial infarction

目的探讨肝素+阿替普酶静脉溶栓治疗急性ST段抬高型心肌梗死(STEMI)的效果。方法选择2017年7月～2018年4月首都医科大学附属北京地坛医院急诊科收治的137例急性STEMI患者,依据随机数字表法分为对照组(67例)与观察组(70例)。对照组采用尿激酶静脉溶栓治疗,观察组则采用肝素+阿替普酶静脉溶栓治疗,通过观察溶栓后心电图变化、心肌酶变化、症状缓解程度以及是否发生再灌注心律失常情况,初步判断是否有溶栓后血管再通,后对其进行进一步补救性PCI,了解其血管再通情况,并继续监测其住院期间发生心源性休克、恶性心律失常、心力衰竭、死亡等事件的情况。结果观察组静脉溶栓治疗再通率高于对照组,差异有高度统计学意义(P <0.01);观察组患者住院期间心血管事件发生率低于对照组,差异有高度统计学意义(P <0.01)。结论肝素联合阿替普酶静脉溶栓治疗效果明显优于尿激酶静脉溶栓治疗,同时还可以降低急性STEMI患者心血管事件发生率。

Objective To discuss the therapeutic effect of Heparin combined with Aheplase as the intravenous thrombolytic therapy treating acute STEMI.Methods From July 2017 to April 2018,in Department of Emergency,Beijing Ditan Hospital,Capital Medical University,137 patients with acute STEMI were selected,they were divided into the control group(67 cases)and the observation group(70 cases)according to the random number table method.The control group was treated with urokinase as the intravenous thrombolysis,and the observation group was treated with Heparin and Aheplase.The changes of electrocardiogram,the changes of myocardial enzymes,the degree of remission of the symptoms and the arrhythmia of reperfusion after thrombolytic treatment were observed,the preliminary judgement whether the blood vessels were reconnected after thrombolytic,and further remedial PCI was performed to determine the recanalization condition indeed,the monitor the incidence of cardiogenic shock,malignant arrhythmia,heart failure and death were continuously given during the period of hospitalization.Results The total efficacy in the observation group was higher than the control group,the difference was statistically significant(P﹤0.01);the incidence of cardiovascular events in the observation group was lower than in the control group,the difference was statistically significant(P﹤0.01).Conclusion Heparin combined with alteplase as the intravenous thrombolytic therapy is superior to urokinase,and can also reduce the incidence of cardiovascular events in STEMI patients.