低分子肝素钠与普通肝素治疗急性冠状动脉综合征的效果比较

目的探讨低分子肝素钠与普通肝素治疗急性冠状动脉综合征（acute coronary syndrome,ACS）的临床疗效。方法将257例ACS患者按随机数字表法分为2组：观察组126例和对照组131例。2组患者均采用硝酸酯类、钙通道阻滞剂、血管紧张素转化酶抑制剂、β-受体阻断剂等治疗。在此基础上,观察组采用低分子肝素钠5 000 U皮下注射,每12小时1次。对照组采用普通肝素5 000 U皮下注射,每12小时1次。2组疗程均为7 d。观察2组患者治疗前、治疗7 d后检测指标[活化的凝血时间（ACT）、活化部分凝血活酶时间（APTT）]的变化及治疗7 d后有无出血、有无心血管事件（严重的心律失常、再发的心绞痛、心肌梗死及心力衰竭等）的发生等情况。结果观察组总有效率高于对照组,差异有统计学意义（P〈0.05）。观察组患者治疗前、治疗7 d后ACT、APTT水平与对照组治疗7 d后比较差异均有统计学意义（均P〈0.05）,对照组患者治疗7 d后ACT、APTT水平均明显高于治疗前（均P〈0.05）。观察组患者出血的发生率明显低于对照组（P〈0.01）,观察组患者心血管事件的发生率与对照组比较差异无统计学意义（P〉0.05）。结论低分子肝素钠治疗ACS疗效确切,且不用监测凝血指标。

Comparison of Low Molecular Weight Heparin and Unfractionated Heparin for Treatment of Acute Coronary Syndrome

Objective To explore the clinical effects of low molecular weight heparin and unfractionated heparin on acute coronary syndrome（ACS）.Methods A total of two hundred five-seven patients with ACS were randomly divided into 2 groups to the number table method：observation group（n=126） and control group（n=131）.All the patients received the conventional drug therapy（Nitrates,calcium channel blockers,angiotensin converting enzyme inhibitors and β-receptor blocker,etc.）.On the basis of the therapy,the patients in observation group were treated with low molecular weight heparin（5 000 U every 12 hours by intraperitoneal injection）,while the patients in control group were intraperitoneally injected with unfractionated heparin（5 000 U every 12 hours）.All patients were treated for 7 days.Activated clotting time（ACT） and activated partial thromboplastin time（APTT） were measured before and after treatment.Cardiovascular events（severe arrhythmia,recurrence of angina,myocardial infarction and heart failure,etc.） and bleeding events were assessed for the comparison between the two groups.Results The total effective rate in observation group was higher than that in control group,and the difference was statistically significant（P〈0.05）.Compared with control group,the levels of ACT and APTT in observation group were significantly different before and after treatment.In control group,the levels of ACT and APTT after 7-day treatment were significantly higher than those before treatment（all P〈0.05）.The incidence of bleeding in observation group was significantly lower than that in control group（P〈0.01）.There were no significant differences in incidence of cardiovascular events between the two groups（P〈0.05）.Conclusion The low molecular weight heparin is effective and safe for treatment of ACS without coagulation monitoring.