摘要
目的探讨急性心肌梗死(AMI)患者溶栓治疗中早期应用低分子肝素的临床疗效。方法选择2015年1月至2017年3月期间榆林市第二医院心内科收治的64例AMI患者为研究对象,根据随机数表法分为观察组和对照组,每组32例,观察组在尿激酶溶栓前开始应用低分子肝素,对照组则在溶栓后12 h开始应用,疗程7 d。比较两组患者冠状动脉再通率、再通时间、再梗死发生率及出血等不良反应发生率、心功能指标[脑钠肽(BNP)、左心室射血分数(LVEF)]的变化和病死率。结果观察组患者的冠状动脉再通率为87.50%,明显高于对照组的68.75%,再通时间为(1.4±0.6)h,明显短于对照组的(2.1±0.8)h,差异均有统计学意义(P<0.05);观察组患者的再梗死率为3.57%,明显低于对照组的18.18%,差异有统计学意义(P<0.05);治疗后,观察组患者的血清BNP水平为(148.3±28.4)pg/m L,明显低于对照组的(172.3±39.2)pg/m L,LVEF为(54.6±7.1)%,明显高于对照组的(49.4±5.8)%,差异均有统计学意义(P<0.05);观察组与对照组患者的不良反应发生率(9.38%vs 6.25%)及病死率(3.13%vs 6.25%)比较,差异均无统计学意义(P>0.05)。结论 AMI患者溶栓治疗过程中早期应用低分子肝素可提高再通率、缩短再通时间并降低再梗死率,可有效改善患者的心功能,并且具有较好的安全性。
Objective To investigate the clinical efficacy of low molecular weight heparin(LMWH) in the early stage of thrombolytic therapy for patients with acute myocardial infarction(AMI). Methods From January 2015 to March 2017, 64 AMI patients treated in the Department of Cardiology of the Yulin Second Hospital were selected and divided into the observation group and the control group according to random number method, with 32 cases in each group. The low molecular weight heparin was used in the observation group before urokinase application, and the low molecular weight heparin was applied 12 h after thrombolytic treatment in the control group. The treatment course was 7 days. The rate of coronary artery recanalization, recanalization time, incidence of reinfarction and bleeding, cardiac function index [BNP, LVEF] and mortality were compared between the two groups. Results The coronary artery recanalization rate of the observation group was 87.50%, which was significantly higher than 68.75% of the control group, and the recanalization time was(1.4±0.6) h, which was significantly shorter than(2.1±0.8) h of the control group(all P<0.05); the reinfarction rate in the observation group was 3.57%, which was significantly lower than 18.18% in the control group(P<0.05). After the treatment, the serum BNP level and LVEF were(148.3±28.4) pg/m L and(54.6±7.1)% in the observation group, versus(172.3±39.2) pg/m L and(49.4±5.8)% in the control group(all P<0.05). The adverse reaction rate and mortality rate were 9.38% and 3.13% in the observation group, versus 6.25% and 6.25% in the control group(all P>0.05).Conclusion The early application of low molecular heparin in AMI patients during thrombolytic therapy can increase recanalization rate, shorten recanalization time and reduce reinfarction rate, which can effectively improve cardiac function and has better safety.
引文
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