溶栓前肝素治疗对急性心肌梗死后左室重构的影响

目的：探讨尿激酶（UK）溶栓前使用肝素对急性心肌梗死（AMI）后左室重构的影响。方法：86例AMI患者随机分为2组：早期肝素组在UK溶栓之前静注肝素，对照组在UK使用前不应用肝素。超声测定左室收缩末期内径（LVSd)和容量（ESV）、舒张末期内径（LVDd)和容量（EDV），计算左室射血分数（EF）和室壁阶段运动积分（RWMI），比较2组的左室重构情况。结果：早期肝素组的ESV和EDV均明显低于对照组（P＜0．55或P＜0．01），RWMI低于对照组（P＜0．05），EF高于对照组（P＜0．05）。早期肝素组的下壁梗死组ESV、EDV、RWMI和EF与对照组比较无统计学差异，前壁梗死组的ESV、EDV、RWMI均低于对照组（P＜0．01或P＜0．05），EF高于对照组（P＜0．01）。结论：早期应用肝素辅助溶栓治疗，可改善左室重构，提高心室功能。

Influence on left ventricular remodeling of thrombolysis using heparin before administration of thrombolytic agent in patients with acute myocardial infarction

Objective:To investigate the influence of a sequential usage of intravenous thrombolysis (prethrombolytic heparinurokinasepostthrombolytic heparin) on left ventricular remodeling and heart function in patients with acute myocardial infarction (AMI).Methods:Eightysix cases of AMI were randomly divided into two groups.Patients in group one (n=48) received early intravenous administration of heparin and urokinase sequentially 〔namely heparinurokinasepostthrombolytic heparin (HUH)〕.Patients in control group (n=38) were treated only by urokinase.The changes of echocardiography on left ventricular endsystolic volume and enddiastolic volume were compared.Results:The left ventricular endsystolic volume,enddiastolic volume and regional wall motion index (RWMI) in the HUH group were less than those in control group and the statistical difference was significant (P<0.05 or P<0.01).The eject fraction of the anterior wall myocardial infarction in HUH group increased significantly more than that in control group (P<0.05).However,there was no significance in cases of inferior wall myocardial infarction.Conclusions:The sequential usage of intravenous thrombolysis of heparinurokinaseheparin in patients with AMI can contribute to the left ventricular remodeling and improve the cardiac function.