摘要
目的比较依诺肝素2种用法联合瑞替普酶(r-PA)与尿激酶(UK)静脉溶栓治疗急性ST段抬高型心肌梗死(STEMI)的疗效及安全性,并比较其对左心功能的影响。方法将121例STEMI患者随机分为r-PA1组(61例)和r-PA2组(60例)。r-PA1组患者溶栓前静脉推注30 mg依诺肝素负荷量,r-PA2组不给予静脉负荷量。选择同时期应用UK治疗的62例STEMI患者为UK组。比较3组患者溶栓90 min临床再通率及出血并发症发生情况,并比较3组患者发病24 h血浆脑钠肽(BNP)水平、发病7 d时左心室舒张末期内径(LVDD)及左心室射血分数(LVEF)。结果r-PA1组和r-PA2组再通率均显著高于UK组(P<0.01);r-PA1组再通率显著高于r-PA2组(P<0.05)。3组出血发生率比较差异无统计学意义(P>0.05)。r-PA1组和r-PA2组血浆BNP水平、LVDD均显著低于UK组,LVEF显著高于UK组(P<0.05);r-PA1组血浆BNP水平显著低于r-PA2组(P<0.05),r-PA1组和r-PA2组LVDD、LVEF比较差异无统计学意义(P>0.05)。结论 r-PA溶栓疗效明显优于UK;r-PA溶栓前静脉给予30 mg依诺肝素负荷量可明显提高再通率,从而更好地保护左心功能,且出血并发症无增加。
Objective To compare the curative effect and safety of different usage of enoxaparin combined with retepla- ser（r-PA） or urokinase（UK） in patients with ST-segment elevation myocardial infarction （STEMI）, and the influence on the left heart function. Methods A total of 121 patients with STEMI were randomly divided into r-PAl group（61 cases） and r- PA2 group（60 cases）. The patients in r-PAl group were given 30 mg of enoxaparin intravenously before thrombolysis while the patients in r-PA2 group had no loading dose before thrombolysis. Sixty-two patients with STEMI undergoing thrombolysis with UK were selected as the UK group. The recanalization rate and incidence of major bleeding complications were compared a- mong the three groups at 90 min after the thrombolytic therapy. And the plasma brain natriuretic peptide（BNP） level 24 h from onset,the left ventricular diastolic diameter（LVDD） and left ventricular ejection fraction（LVEF） 7 days from onset were com- pared,too. Results The recanalization rate in both r-PAl group and r-PA2 group was significantly higher than that in UK group（ P 〈 O. 01 ）. Tile recanalization rate in r-PAl group was significantly higher than that in r-PA2 group（ P 〈 0. 05 ）. There was no statistically significant difference about the incidence of bleeding among the three groups（P 〉 0.05）. The plasma BNP level and LVDD in both r-PAl group and r-PA2 group were significantly lower than that in UK group. On the contrary, LVEF was significantly higher than that in UK group（ P 〈 0.05 ）. The plasma BNP level in r-PAl group was significantly lower than that in r-PA2 group（P 〈 0.05 ）. The LVDD and LVEF between the r-PAl group and r-PA2 group had no statistical signifi- cance （ P 〉 0.05 ）. Conclusion r-PA was more effective than UK in patients undergoing thrombolysis. Administration of enox- aparin 30 mg intravenously before thrombolysis could obviously improve recanalization rate, so as to provide better protection for heart function with no increase of major bleeding complications.
出处
《新乡医学院学报》
CAS
2015年第8期770-773,共4页
Journal of Xinxiang Medical University
关键词
瑞替普酶
依诺肝素
尿激酶
急性心肌梗死
脑钠肽
reteplase
enoxaparin
urokinase
acute myocardial infarction
brain natriuretic peptide
