| 摘要: |
| ［摘要］目的 探讨急性心肌梗死（acute myocardial infarction，AMI）低分子肝素在阿替普酶（Alteplase，rt-PA）溶栓治疗的应用，并与溶栓治疗中传统抗凝药物普通肝素相比较．方法 选取AMI患者35例，其中研究组15例，对照组20例，均给予阿替普酶静脉溶栓治疗；研究组溶栓前即刻静脉注射依诺肝素素30 mg，溶栓后15 min皮下注射依诺肝素40 mg，以后每12 h皮下注射依诺肝素40 mg，共5 d；对照组：溶栓前即刻静脉注射普通肝素4 000 U（或 60 U/kg），后以800～1 000 U/h 静脉泵入普通肝素，依据部分凝血活酶时间（APTT值）调整肝素用量，每3 h测一次凝血常规，使APTT维持于正常对照的1.5～2.0倍（50～70 s），48 h后改为皮下注射依诺肝素每12 h 40 mg，共5 d．所有患者均给予指南推荐的常规治疗．结果 研究组达到临床再通及冠脉再通标准为86.66%，再通时间平均（1.62±0.36）h；对照组为65.00%，再通时间（1.81±0.33）h．2组再通率及再通时间比较差异无统计学意义（P＞0.05）．出血并发症研究组1例（6.66%），对照组5例（25%），2组均未出现颅内出血等严重或致命性出血．结论 急性心肌梗死使用阿替普酶溶栓治疗中抗凝药物选用低分子肝素疗效不低于传统普通肝素，但方法简便、操作简化，不必反复监测凝血指标，减轻了临床工作负担，优化了溶栓流程，适合向基层及急救系统推广应用． |
| 关键词: ［关键词］急性心肌梗死 低分子肝素 静脉溶栓疗法 |
| DOI： |
| 分类号: |
| 基金项目:［基金项目］云南省自然科学基金资助项目(2013FZ258) |
|
| Clinical Study of Low Molecular Weight Heparin Combined with Alteplase for Thrombolysis |
|
LI Ting-ting
|
|
（Dept. of Cardiology，The Sixth Affiliated Hospital of Kunming Medical University，People’s Hospital of Yuxi City，Yuxi Yunnan 653100，China）
|
| Abstract: |
| ［Abstract］Objective The aim of this study was to investigate the application of low molecular weight heparin combined with alteplase for thrombolysis in patients with acute myocardial infarction（AMI），and to compare its thrombolysis effect with traditional anticoagulant-general heparin. Methods 35 AMI patients with alteplase intravenous thrombolytic therapy were divided into two groups，among which 15 cases in the study group were treated with 30 mg enoxaparin instant intravenous injection before thrombolysis，40 mg enoxaparin hypodermic injection 15 minutes after thrombolysis，40 mg enoxaparin hypodermic injection every 12 hours for 5 days. The other 20 cases were assigned to the control group and treated with 4 000 u（or 60 u/kg）general heparin instant intravenous injection，then pumped general heparin intravenously in the rate of 800-1 000 u/h. Meanwhile， detected coagulation convention every 3 hours and adjusted the dose of heparin according to the activated partial thromboplastin time（APTT）to keep APTT value within 1.5 to 2.0 times （50-70 s） the standard value. 48 hours later， patients in the control group was given hypodermic injection of 40 mg enoxaparin every 12 hours for 5 days. All cases were given regular treatment as guidelines recommended. Results The patency rate of infarct-related coronary artery assessed by unified clinical criteria was 86.66% and 65.00%， and the average recanalization time was（1.62±0.36）h and （1.81±0.33）h in the study and control groups， respectively. There were no significant differences on patency rate and recanalization time between the two groups（P > 0.05）. One case of bleeding complication occurred in the study group（6.66%），while five cases occurred in the control group（25.00%）. In the two groups，no cases appeared intracranial hemorrhage and other serious or fatal bleeding occurred. Conclusion The clinical efficacy of low molecular weight heparin was non-inferior to general heparin in AMI patients with alteplas thrombolysis. The application of low molecular weight heparin was simple and easy to operate. It can optimize the procedure of thrombolysis，reduce repetitive coagulation index monitoring and lessen clinical workload，which is worth being promoted to primary hospital and the emergency systems. |
| Key words: ［Key words］Acute myocardial infarction Low molecular weight heparin Intravenous thrombolytic therapy |