磺达肝癸钠治疗老年急性ST段抬高型心肌梗死的有效性和安全性临床研究

目的 比较磺达肝癸钠和依诺肝素治疗ST段抬高型心肌梗死(STEMI)患者的疗效和安全性.方法 入选65岁以上老年STEMI患者169例,所有患者均于住院期间行经皮冠状动脉介入术(PCI),术后完全随机分为观察组(n=85)和对照组(n=84).48 h普通肝素抗凝后,观察组患者给予磺达肝癸钠2.5 mg,1次/d,对照组患者给予依诺肝素钠100 AxaIU/kg,每12小时1次.2组患者均连用7d.从PCI术后即刻开始随访至出院后1个月,记录血常规、尿常规、血生化、超声心动图检查结果及主要不良心血管事件和不良反应的发生情况.结果 2组均无心源性死亡、非致死性心肌梗死发生,观察组5例(5.9％)发生反复不稳定型心绞痛(UAP),对照组4例(4.8％)发生反复UAP,2组反复UAP发生率差异无统计学意义(P＞0.05).2组抗凝疗效相似.抗凝治疗前后,2组血常规、尿常规、血生化、超声心动图指标比较,差异无统计学意义(P＞0.05).2组均无大出血及皮疹发生,对照组总的小出血发生率[7.1％(6/84)]略高于观察组[3.5％(3/85)],但差异无统计学意义(P＞0.05).结论 对于65岁以上STEMI患者,应用磺达肝癸钠抗凝治疗有效、安全,与依诺肝素相比,磺达肝癸钠的小出血事件较少,在减少出血风险方面具有潜在优势.

Clinical study on efficiency and safety of fondaparinux in the elder patients with acute ST elevated myocardial infarction

Objective To explore the efficiency and safety of Fondaparinux in the elder patients with acute ST elevated myocardial infarction（STEMI）. Methods All 169 cases （ 〉 65 years） with acute STEMI were selected and percutaneous coronary intervention （PCI） were performed on all cases. All 169 cases were after PCI. The patients in observation group were given fondaparinux, 2.5 mg, and patients in control group were given enoxaparin, 100AxaIU/kg, q12h after persistent 48-hour intravenous injection of heparin. The follow-up was performed one month after discharge. Paramenters of blood rountine, urine routine, biochemical analysis, electrocardiography, echocardiography, major adverse cardiovascular events （MACE） and adverse effects in both groups were recorded. Results There were no cardiogenic death and non-fatal infarction in both groups, but there were 5 unstable angina pectoris（UAP） in observation group and 4 cases with UAP in control group. There was no difference in blood rountine, urine routine, biochemical analysis, electrocardiography and echocardiography in both groups. The incidence of mini-bleeding events was 3.5% （3/85） in observation group, which was lower than that [ 7.1% （6/84） ] in control group, but there was no significant difference （P 〉 0.05 ）. Conclusion Fondaparinux used in the elder patients with acute STEMI is effective and safe, and fondaparinux has potential advantage on hemorrhage risk compared with enoxaparin.