低分子肝素在急性心肌梗死患者溶栓治疗中的早期应用价值
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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.
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
[1]赵景宏,王浩宇,乔彦,等.急性心肌梗死患者介入治疗后远期心功能改善的临床研究[J].海南医学,2016,27(19):3140-3142.
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[9]江丽.急性心肌梗死溶栓治疗的药物经济学评价[J].中国实用医药,2008,3(36):101-103.
[10]沈静,张杰,严佳斌,等.急性心肌梗死溶栓治疗对凝血及纤溶指标的影响[J].检验医学与临床,2012,9(24):3127,3132.
[11]杨劲松,杨海松.药物溶栓对急性心肌梗死病人凝血与纤溶系统的影响[J].吉林医药学院学报,2012,33(6):387-388.
[12]王燕.小剂量尿激酶与低分子肝素钙联合治疗进展性脑血栓的临床观察[J].中国实用医药,2016,11(11):159-160.
[2]许浩,杨汉东,闵新文,等.急性冠脉综合征急诊PCI心血管不良事件与血清肌钙蛋白水平的关系[J].海南医学,2016,27(1):32-34.
[3]张纪梅.尿激酶溶栓治疗发病2 h内急性ST段抬高型心肌梗死的疗效[J].中国老年学杂志,2013,33(1):170-171.
[4]中华医学会心血管病学分会.急性心肌梗死诊断和治疗指南[S].中华心血管病杂志,2001,29(12):710-725.
[5]陈伟伟,高润霖,刘力生,等.《中国心血管病报告2015》概要[J].中国循环杂志,2016,31(6):521-528.
[6]李美红,朱强锋,陈赛勇,等.早发急性心肌梗死患者预后影响因素研究[J].海南医学,2013,24(9):1280-1282.
[7]王江友,苏晞.急性心肌梗死患者冠状动脉微血管功能障碍和阻塞机制的研究进展[J].中华老年心脑血管病杂志,2016,18(9):996-998.
[8]刘文辞,刘慧敏.急性心肌梗死溶栓成功与未行溶栓患者的心功能及左室重构变化分析[J].山东医药,2011,51(45):102-103.
[9]江丽.急性心肌梗死溶栓治疗的药物经济学评价[J].中国实用医药,2008,3(36):101-103.
[10]沈静,张杰,严佳斌,等.急性心肌梗死溶栓治疗对凝血及纤溶指标的影响[J].检验医学与临床,2012,9(24):3127,3132.
[11]杨劲松,杨海松.药物溶栓对急性心肌梗死病人凝血与纤溶系统的影响[J].吉林医药学院学报,2012,33(6):387-388.
[12]王燕.小剂量尿激酶与低分子肝素钙联合治疗进展性脑血栓的临床观察[J].中国实用医药,2016,11(11):159-160.