急性ST段抬高型心肌梗死溶栓过程中普通肝素及依诺肝素的应用比较

Unfractionated heparin and enoxaparin in thrombolysis of acute ST-segment elvation myocardial infarction

目的 比较普通肝素及依诺肝素在瑞替普酶治疗急性ST段抬高型心肌梗死(STEMI)中的差异。方法 将70例STEMI患者按给药方式分为普通肝素组和依诺肝素组,每组35例。两组均采用瑞替普酶进行溶栓治疗,普通肝素组溶栓前先静脉注射普通肝素4000U负荷量,接着以12U/(kg·h)维持静脉滴注48h,根据活化部分凝血酶时间(APTT)调整普通肝素剂量,48h后逐渐减量改用皮下注射依诺肝素40mg,2次/d,序贯治疗(2~7)d或至转运。依诺肝素组溶栓前先给予依诺肝素30mg静脉注射,15min后1mg/kg皮下注射,1次/12h,治疗(2~7)d或至转运。比较两组患者临床治疗效果,统计并发症发生率,并进行成本-效果分析。结果 60min时普通肝素组再通率为83%,依诺肝素组为57%,120min时普通肝素组再通率为100%,依诺肝素组为91%,普通肝素组明显高于依诺肝素组(P<0.05);普通肝素组临床再通时间显著短于依诺肝素组(P<0.05);普通肝素组肌钙蛋白I(TnI)、肌酸激酶同工酶(CK-MB)峰值显著低于依诺肝素组(P<0.05);普通肝素组并发症总发生率显著低于依诺肝素组(P<0.05);普通肝素组成本-效果比显著低于依诺肝素组(P<0.05)。结论 用瑞替普酶进行溶栓治疗STEMI时,先用普通肝素冲击并足量维持48h后用依诺肝素序贯治疗较全程应用依诺肝素方便、经济、安全、疗效显著。

AIM To compare the differences of unfractionated heparin and enoxaparin treatment of acute ST-segment elevation myocardial infarction in reteplase.METHODS 70 patients with acute STsegment elevation myocardial infarction were divided into groups of A and B,with 35 patients in each group.The reteplase was adopted for thrombolytic therapy for patients in both Group A and Group B.Patients in Group A were injected with 4000 U of unfractionated heparin through the intravenous injection before thrombolysis and then to maintain 12 U/(kg·h)intravenous infusion of 48 h,according to the APTT to adjust the dose of unfractionated heparin,48 h gradually after the reduction to subcutaneous enoxaparin 40 mg 2 times daily,sequential treatment of 2-7 d or to referral.Patients in Group B were injected with 30 mg of enoxaparin through intravenous injection before the thrombolysis and then subcutaneous injection with 1 mg/kg of enoxaparin after 15 min,every 12 h,treatment 2-7 d or to referral.Comparison of clinical therapy effects of patients in the two groups was performed with statistical analysis conducted on complication probability and analysis on cost-effects.RESULTS At 60 min,the vessel repass rate of patients in Group A was 83%,that of patients in Group B was 57%;at 120 min,the vessel repass rates of patients in Group A and Group B were 100%and 91%,respectively.The vessel repass rate of patients in Group A were higher than that of Group B patients with statistical significance(P<0.05).The vessel repass time of Group A patients was shorter than that of Group B patients with statistical significance(P<0.05).The TnI and CK-MB peaks of Group A patients were statistically lower than that of Group B patients(P<0.05).The total complication probability of Group A patients was statistically lower than Group B patients(P<0.05).The cost-effect ratio of Group A was lower than Group B,with statistical significance(P<0.05).CONCLUSION In therapy for acute ST-segment elevation myocardial infarction,if reteplase is selected for thrombolytic therapy,it is more convenient,economical,safer and has better therapeutic effects to adopt unfractionated heparin in sufficient dosage for 48 h and subsequent of use enoxaparin when compared with use of enoxaparin during the entire therapy process.