摘要
目的 :分析低分子量肝素 ( LMWH)对高龄不稳定型心绞痛 ( UAP)患者凝血指标及疗效的影响。方法 :UAP患者 40例 ,年龄 75～ 86岁。给予 LMWH( Fraxiparine,商品名速避凝 ) 0 .4m L,腹壁皮下注射 ,每 1 2 h一次 ,疗程 7d。于用药前、末次用药后 4h和 1 2 h分别抽血测定抗 Xa因子活性、血浆凝血酶原时间 ( PT)、活化部分凝血活酶时间 ( APTT)、血浆 D-二聚体 ( D- Dimer)、血浆组织型纤溶酶原激活物 ( t PA)活性、血浆纤溶酶原激活物抑制物 ( PAI)及抗凝血酶血 - ( AT- )。并且根据临床症状、硝酸甘油用量和 ECG变化判定显效、有效或无效。结果 :实验室检测结果显示 ,用药后 PT、APTT轻度延长 ;血浆抗 Xa活性显著增高 ( P<0 .0 5 ) ;D- Dimer含量在 LMWH注射后显著降低 ( P<0 .0 5 ) ;t- PA活性较之用药前显著升高 ( P<0 .0 5 )。36例 ( 87.5 %)用药后症状明显改善 ,其中显效 2 4例 ,有效 1 2例。4例治疗无效者经 PTCA治疗后症状改善。结论 :LMWH治疗高龄 UAP患者临床疗效显著、稳定 ,皮下注射 ,每 1 2 h一次 ,可以获得持续的抗血栓效果 。
Objective:To assess the influence of low molecular weight heparin (LMWH) on coagulation,fibrinolysis and anticoagulation systems in very elderly patients with unstable angina pectoris (UAP).Methods:Forty patients at the age of 80 with UAP were treated with LMWH (Fraxiparine) subcutaneously once every 12 h for 7 days.The plasma PT,APTT,AXa,D Dimer,tPA,PAI and AT Ⅲ were detected before treatment,4h and 12h after the last subcutaneous injection.The clinical efficacy (high effective,effective or no efficacy) was evaluated according to the improvements of symptoms,signs and ECG,and the total dose of nitroglycerin used.Results:The laboratory results showed that PT and APTT prolonged slightly ( P <0 05),AXa and tPA levels increased ( P <0 05),and D Dimer activity decreased ( P <0 05) after treatment.Of the 40 patients,36 (87 5%) improved significantly in clinical symptoms;4 were not controlled by LMWH and improved after changing to percutaneous transluminal coronary angioplasty (PTCA) therapy.Conclusion:LMWH can be effectively used in very elderly patients with UAP without laboratory determination.
出处
《滨州医学院学报》
2004年第1期4-6,共3页
Journal of Binzhou Medical University
