普通肝素或低相对分子质量肝素联合瑞替普酶治疗急性心肌梗死的对比研究

目的观察对比普通肝素钠（UH）或国产低相对分子质量肝素钠（LMWH）抗凝联合瑞替普酶静脉溶栓治疗ST段抬高型急性心肌梗死（AMI）的疗效及安全性。方法 50例ST段抬高型AMI患者,随机分为UH组（25例）和LMWH组（25例）,分别在常规瑞替普酶（10 mu＋10 mu）静脉溶栓基础上接受UH钠或国产LMWH钠抗凝治疗,观察溶栓后48 h内两组患者的溶栓再通率、出血发生率及出血相关死亡率。结果 48 h内,两组溶栓再通率比较无统计学差异（P〉0.05）;UH组出血发生率为100%,出血直接导致的死亡率为20%;LMWH组出血发生率为4%,无1例因出血并发症死亡者。结论 LMWH钠联合瑞替普酶治疗ST段抬高型AMI疗效确切,在降低出血并发症方面较UH钠有明显的优势（P〈0.05）。

Study of Reteplase and Unfractionated Heparin(UH) or Low Molecular Weight Heparin(LMWH)as Reperfusion Therapy in the Patients with Acute Myocardial Infarction

Objective To observe and compare with the efficacy and safety of using unfractionated heparin(UH) or low molecular weight heparin(LMWH) for anticoagulation therapy and reteplase for intravenous thrombolysis therapy in the patients with ST-segment elevation acute myocardial infarction(AMI). Methods 50 patients with ST-segment elevation AMI were in the inclusion criteria and randomly divided into UH group(n=25) and LMWH group(n=25),after conventional intravenous thrombolysis therapy with reteplase(10 mu+10 mu),two groups were treated with UH and LMWH for anticoagulation respectively.Within 48 hours after thrombolytic,recanalization rate,the incidence of hemorrhage and hemorrhage-related mortality were observed in two groups of patients. Results Within 48 hours,the thrombolytic recanalization rate between two groups was no significant difference(P>0.05).The incidence of hemorrhage in UH group was 100%,hemorrhage-related mortality was 20%;in the group of LMWH,the incidence of hemorrhage was 4%,but there were no patients died from hemorrhage-related complications. Conclusions The treatment combined LMWH with reteplase for ST-segment elevation AMI is effective,and compared with UFH has an obvious advantage in reducing hemorrhage-related complications(P<0.05).