摘要
目的探讨低分子肝素早期使用对急性心肌梗死患者溶栓效果的影响。方法选择2015年1月至2017年8月期间东莞市长安医院急诊科收治的72例急性心肌梗死(AMI)患者为研究对象,根据随机数表法分为观察组(n=36)与对照组(n=36),两组患者均予尿激酶静脉溶栓治疗,对照组常规在溶栓后12h应用低分子肝素,观察组则在溶栓前应用低分子肝素,疗程均为1周,比较两组患者血管再通情况、心电图ST-T段回落≥50%的时间、出血不良反应发生情况和病死率。两组患者在溶栓前及溶栓12 h后,测定血清超敏C反应蛋白(hs-CRP)及白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)水平。结果观察组患者的再通率为88.89%,明显高于对照组的69.44%,再通时间及ST-T段回落≥50%的时间分别为(1.47±0.62)h、(2.18±0.75)h,均明显短于对照组的(2.06±0.95)h、(2.69±1.08)h,差异均有统计学意义(P<0.05);观察组治疗后的血清hs-CRP、IL-6及TNF-α水平分别为(4.82±1.94)mg/L、(13.36±4.23)pg/m L、(23.22±4.63)pg/m L,明显低于对照组的(7.16±2.48)mg/L、(20.16±5.15)pg/m L、(30.65±6.74)pg/m L,差异均有统计学意义(P<0.05);观察组患者的出血并发症发生率为13.89%,病死率为5.56%,分别与对照组的8.33%和8.33%比较,差异均无统计学意义(P>0.05)。结论低分子肝素在急性心肌梗死患者溶栓治疗过程中早期应用可有效调节患者细胞炎症因子水平,提高再通率,缩短再通时间,且不增加出血风险。
Objective To investigate the effect of early use of low-molecular-weight heparin on thrombolytic effect in patients with acute myocardial infarction. Methods A total of 72 patients of acute myocardial infarction（AMI） treated in Emergency Department of Dongguan Changan Hospital from January 2015 to August 2017, according to random number table, were selected and divided into observation group（n=36） and control group（n=36）, which were all treated with intravenous thrombolytic therapy. The control group applied low-molecular-weight heparin 12 h after thrombolysis, and the observation group used low-molecular-weight heparin before thrombolytic therapy, for one week. Vascular recanalization, time of ECG ST-T segment fall≥50%, bleeding adverse reactions, and mortality were compared between the two groups. The levels of serum hypersensitive C reactive protein（hs-CRP）, interleukin-6（IL-6）, and tumor necrosis factor-α（TNF-α） were measured in the two groups before and after（12 h） thrombolytic therapy. Results The recanalization rate（88.89%） in the observation group was significantly higher than 69.44% in the control group. The recanalization time and time of ST-T segment fall≥50% were（1.47±0.62） h and（2.18±0.75） h, significantly shorter than（2.06±0.95） h and（2.69±1.08） h in the control group（P〈0.05）. The hs-CRP, IL-6 and TNF-α in the observation group were（4.82±1.94） mg/L,（13.36±4.23） pg/m L and（23.22±4.63） pg/m L respectively, which were significantly lower than（7.16 ± 2.48） mg/L,（20.16 ± 5.15） pg/m L and（30.65 ± 6.74） pg/m L in the control group（P〈0.05）. The complication rate（13.89%） and mortality（5.56%） in observation group and control group（8.33% and 8.33%） showed no statistically significant difference（P〉0.05）. Conclusion Early application of low-molecular-weight heparin in thrombolytic therapy for acute myocardial infarction patients can effectively regulate the level of inflammatory cytokines, improve the recanalization rate, shorten the recanalization time, and not increase the risk of bleeding.
作者
张拥军
林奋强
卫玉光
ZHANG Yong-jun;LIN Fen-qiang;WEI Yu-guang(Emergency Department 1. Faculty of Pharmaceutical Sciences;Doagguan Changan Hospital, Dongguan 523305, Guangdong, CHINA)
出处
《海南医学》
CAS
2018年第12期1639-1641,共3页
Hainan Medical Journal
关键词
急性心肌梗死
低分子肝素
尿激酶
疗效
炎症因子
Acute myocardial infarction
Low-molecular-weight heparin
Urokinase
Curative effect
Inflammatory factors
