早期肝素化对急性前壁心肌梗死直接行经皮冠状动脉介入治疗患者的疗效

Efficacy of early heparin therapy in patients with acute anterior myocardial infarction undergoing primary percutaneus coronary intervention

目的探讨早期肝素化对急性前壁心肌梗死患者梗死相关动脉血流及心功能的影响。方法入选2017年4月至2018年11月期间天津市武清区人民医院收治的急性前壁心肌梗死患者100例,分为观察组和对照组,每组50例。观察组确诊急性ST段抬高型心肌梗死(STMEI)后,即刻静脉注射普通肝素4 000 U;对照组患者在导管室置入鞘管后,静脉注射普通肝素4 000 U。所有患者均接受了急诊经皮冠状动脉介入(PCI)治疗。观察2组患者肝素给药时间、术前活化凝血时间(ACT)、冠状动脉造影梗死相关动脉血流情况、入院门至球囊扩张(D-to-B)时间、血管开通时间、高敏肌钙蛋白T(hs-TnT)峰值、B型脑钠肽前体(pro-BNP)峰值、住院期间泵衰竭、左室射血分数(LVEF)、住院天数。采用SPSS 13.0软件进行数据处理,依据数据类型,组间比较分别采用t检验或χ~2检验。结果观察组患者首次肝素给药时间[(7.5±1.8)vs(47.4±8.6)min]、造影即刻心肌梗死溶栓治疗(TIMI)0级比例(28%vs 38%)、D-to-B时间[(58.4±13.0)vs(63.9±12.9)min]、血管开通时间[(29.2±5.9)vs(32.5±5.4)min]、高血栓负荷比例(30%vs 52%)、hs-TnT峰值[(2 915.4±1 845.9)vs(3 987.4±2 018.8)ng/ml]、pro-BNP峰值[(3 096.4±1 965.2)vs(4 770.5±2 073.5)pg/ml]、住院泵衰竭比例(4%vs 16%)、住院天数[(9.0±1.8)vs(10.1±2.0)d]明显低于对照组,差异均有统计学意义(P<0.05)。观察组患者ACT[(213.2±13.7)vs(67.7±5.1)s]、TIMI 2～3级比例(40.0%vs 18.0%)、LVEF[(56.5±7.7)%vs(51.3±7.0)%]显著高于对照组,差异均有统计学意义(P<0.05)。结论早期肝素化可提高急性前壁心肌梗死患者罪犯血管再通率,缩短血管开通时间,改善心功能。

Objective To determine the effect of early heparin therapy on blood flow of infarct-related arteries and heart function in patients with acute anterior myocardial infarction.Methods One hundred patients suffering from acute anterior myocardial infarction admitted to our hospital from April 2017 to November 2018 were enrolled in this study.They were randomly divided into observation group and control group,with 50 cases in each group.The patients of the observation group were given intravenous injection of 4 000 U unfractionated heparin immediately after diagnosis of ST-segment elevation myocardial infarction(STMEI).While the same dose of heparin was injected intravenously to the patients from the control group after insertion of sheath.Then all of the patients underwent percutaneus coronary intervention(PCI).The heparin administration time,activated coagulation time(ACT),blood flow of infarct-related arteries by coronary angiography,hospital door to balloon(D-to-B)time,vessel opening time,peak high-sensitive troponin T(hs-TnT)value,peak pro-brain natriuretic peptide(pro-BNP)value,pump failure during hospital stay,left ventricular ejection fraction,and length of hospital stay were observed and recorded in the 2 groups.SPSS statistics 13.0 was used to perform the statistical analysis.Student′s t test or Chi-square test was employed for comparison between the groups based on different data types.Results The observation group had significantly shorter heparin administration time[(7.5±1.8)vs(47.4±8.6)min],lower ratio of TIMI flow grade 0(28%vs 38%),shorter D-to-B time[58.4±13.0)vs(63.9±12.9)min],shorter vessel opening time[(29.2±5.9)vs(32.5±5.4)min],lower ratio of high thrombosis burden(30%vs 52%),lower value of peak hs-TnT[(2 915.4±1 845.9)vs(3 987.4±2 018.8)ng/ml],lower value of peak pro-BNP[(3 096.4±1 965.2)vs(4 770.5±2 073.5)pg/ml],lower ratio of pump failure(4%vs 16%),and shorter length of hospital stay[(9.0±1.8)vs(10.1±2.0)d]when compared with the control group(P<0.05).What′s more,longer activated coagulation time[(213.2±13.7)vs(67.7±5.1)s],higher ratio of TIMI flow grade 2-3(40.0%vs 18.0%),and higher LVEF[(56.5±7.7)%vs(51.3±7.0)%]were observed in the observation group(P<0.05).Conclusion Early heparin therapy promotes recanalization of infarct-related arteries,shortens vessel opening time,and improves heart function in acute anterior myocardial infarction patients.