早期肝素化对急性ST段抬高心肌梗死患者直接PCI术的疗效研究

The effect of early heparinization on PCI in patients with acute ST-segment elevation myocardial infarction

目的研究早期肝素化对急性ST段抬高心肌梗死(STEMI)患者直接经皮冠状动脉介入术(PCI)的疗效研究。方法选取2021年1~12月复旦大学附属中山医院青浦分院STEMI患者100例,随机数表法分为观察组和对照组,每组50例。入组后即刻口服负荷量抗血小板药物。观察组即刻应用负荷量普通肝素(UFH)100 IU/kg静脉推注。对照组在导管室置入桡动脉鞘管后,经鞘管注射UFH 2500 IU。PCI前按总量100 IU/kg追加剩余肝素剂量。观察两组PCI术前、术中及术后相关指标。结果两组在首次医疗接触(FMC)至抗凝时间、血栓抽吸、预扩张次数、预扩张压力、TIMI 2~3级血流、无复流及慢血流、血栓自溶、门球时间(D-to-B)及手术耗用时间等,差异有统计学意义(P<0.05)。两组指标ST段回落率≥70%、无明显回落、高敏肌钙蛋白T(hs-TnT)峰值、N末端脑钠肽前体(NT-proBNP)峰值、hs-TnT达峰值时间等,差异有统计学意义(P<0.05)。结论早期静脉肝素化可安全有效地提高梗死相关动脉(IRA)再通率,缩短血管开通时间,减少PCI术后无复流的发生率,降低出血事件,进一步提高STEMI患者救治率、改善患者预后。

Objective To investigate the effect of early heparinization on primary percutaneous coronary intervention(PCI)in patients with acute ST-segment elevation myocardial infarction(STEMI).Methods A total of 100 STEMI patients diagnosed in the chest pain center or emergency department of our hospital from January 2021 to December 2021 were selected as the study subjects,and were divided into observation group and control group according to random number table method,with 50 patients in each group.All patients were orally loaded with antiplatelet drugs immediately after enrollment.The observation group received intravenous injection of UFH with 100IU/kg load immediately after diagnosis,and the control group received injection of UFH with 2500IU through the radial artery sheath after implantation in the catheter room.before PCI,the remaining heparin dose was added with a total amount of 100IU/kg.In both groups,UFH 1000 IU was added every 1h after PCI.The related indexes before,during and after PCI were observed in the two groups.Results FMC to anticoagulant time、thrombus aspiration、times of predilation、predilation pressure、TIMI level 2-3 blood flow、no reflow and slow blood flow、thrombus autolysis and D-B time in both groups,The results of operation time consumption were statistically different(P<0.05).there were statistical differences in ST segment drop rate≥70%、no significant drop、hs-TNT peak、NT-proBNP peak、hs-TNT peak time.Conclusion Early heparinization can safely and effectively improve IRA reperfusion,shorten vascular opening time,reduce the incidence of no-reflow after PCI,reduce bleeding events.