急性ST段抬高型心肌梗死溶栓过程中普通肝素及依诺肝素的应用比较

目的 比较普通肝素及依诺肝素在瑞替普酶治疗急性ST段抬高型心肌梗死(STEMI)中的差异。方法 将70例STEMI患者按给药方式分为普通肝素组和依诺肝素组,每组35例。两组均采用瑞替普酶进行溶栓治疗,普通肝素组溶栓前先静脉注射普通肝素4000U负荷量,接着以12U/(kg·h)维持静脉滴注48h,根据活化部分凝血酶时间(APTT)调整普通肝素剂量,48h后逐渐减量改用皮下注射依诺肝素40mg,2次/d,序贯治疗(2~7)d或至转运。依诺肝素组溶栓前先给予依诺肝素30mg静脉注射,15min后1mg/kg皮下注射,1次/12h,治疗(2~7)d或至转运。比较两组患者临床治疗效果,统计并发症发生率,并进行成本-效果分析。结果 60min时普通肝素组再通率为83%,依诺肝素组为57%,120min时普通肝素组再通率为100%,依诺肝素组为91%,普通肝素组明显高于依诺肝素组(P<0.05);普通肝素组临床再通时间显著短于依诺肝素组(P<0.05);普通肝素组肌钙蛋白I(TnI)、肌酸激酶同工酶(CK-MB)峰值显著低于依诺肝素组(P<0.05);普通肝素组并发症总发生率显著低于依诺肝素组(P<0.05);普通肝素组成本-效果比显著低于依诺肝素组(P<0.05)。结论 用瑞替普酶进行溶栓治疗STEMI时,先用普通肝素冲击并足量维持48h后用依诺肝素序贯治疗较全程应用依诺肝素方便、经济、安全、疗效显著。

Unfractionated heparin and enoxaparin in thrombolysis of acute ST-segment elvation myocardial infarction

AIM To compare the differences of unfractionated heparin and enoxaparin treatment of acute ST-segment elevation myocardial infarction in reteplase. METHODS 70 patients with acute ST-segment elevation myocardial infarction were divided into groups of A and B, with 35 patients in each group. The reteplase was adopted for thrombolytic therapy for patients in both Group A and Group B. Patients in Group A were injected with 4000 U of unfractionated heparin through the intravenous injection before thrombolysis and then to maintain 12 U/(kg·h) intravenous infusion of 48 h, according to the APTT to adjust the dose of unfractionated heparin, 48 h gradually after the reduction to subcutaneous enoxaparin 40 mg 2 times daily, sequential treatment of 2-7 d or to referral. Patients in Group B were injected with 30 mg of enoxaparin through intravenous injection before the thrombolysis and then subcutaneous injection with 1 mg/kg of enoxaparin after 15 min, every 12 h, treatment 2-7 d or to referral. Comparison of clinical therapy effects of patients in the two groups was performed with statistical analysis conducted on complication probability and analysis on cost-effects. RESULTS At 60 min, the vessel repass rate of patients in Group A was 83%, that of patients in Group B was 57%; at 120 min, the vessel repass rates of patients in Group A and Group B were 100% and 91%, respectively. The vessel repass rate of patients in Group A were higher than that of Group B patients with statistical significance (P < 0.05). The vessel repass time of Group A patients was shorter than that of Group B patients with statistical significance (P < 0.05). The TnI and CK-MB peaks of Group A patients were statistically lower than that of Group B patients (P < 0.05). The total complication probability of Group A patients was statistically lower than Group B patients (P < 0.05). The cost-effect ratio of Group A was lower than Group B, with statistical significance (P < 0.05). CONCLUSION In therapy for acute ST-segment elevation myocardial infarction, if reteplase is selected for thrombolytic therapy, it is more convenient, economical, safer and has better therapeutic effects to adopt unfractionated heparin in sufficient dosage for 48 h and subsequent of use enoxaparin when compared with use of enoxaparin during the entire therapy process.