肝素在老年急性冠状动脉综合征患者介入治疗后的应用

摘要:目的探讨老年急性冠状动脉综合征(ACS)患者PCI术后如何应用普通肝素(UFH)抗凝。方法选择接受PCI的老年ACS患者100例。所有患者采用静脉UFH抗凝至少24 h,并随机分为试验组(50倒)和对照组(50例)。试验组按预先设定的UFH标准化抗凝方案调节剂量,对照组由值班医师凭经验调整剂量。以活化部分凝血活酶时间(APTT)45～75 s作为UFH抗凝治疗范围。结果试验组和对照组分别测量APTT 328次和351次,两组抗凝达标比例分别为80.2%和47.3%(P<0.01)。试验组达到治疗范围的平均时间明显小于对照组(2.9±3.4)h vs (7.6±3.4)h,P<0.01];试验组24 h维持在治疗范围内的平均时间明显大于对照组(16.9±3.5)h vs(11.6±4.1)h,P<0.01]。结论 UFH标准化抗凝方案可以安全有效地应用于老年ACS患者PCI术后抗凝。

Application of unfractionated heparin in elderly patients with acute coronary syndrome after PCI

Objective To explore the utility of unfractionated heparin(UFH) in elderly patients with acute coronary syndrome(ACS) after percutaneous coronary intervention(PCI). Methods 100 elderly patients with ACS undergoing PCI were enrolled in this study. All patients were treated with intravenous UFH for at least 24 hours,and divided into two groups. UFH was adjusted according to our standard protocol in the study group and according to physician-guided dosing practice in the control group. The therapeutic activated partial thromboplastin time(APTT) range was defined as 45～75 seconds. Results In the study group,263 of 328 times(80.2%) achieved the therapeutic threshold within 24 hours,compared with 166 of 351 times(47.3%) in the control group(P<0.01).Patients more rapidly achieved therapeutic APTT(2.9±3.4) h vs (7.6± 3.4) h, P<0.01],and were in therapeutic range for longer time in the study group compared with the control group(16.9±3.5) h vs (11.6±4.1) h, P<0.01]. Conclusions The present study confirms the superiority of the weight-based heparin regimen for treatment of elderly patients with ACS after PCI. This protocol is clinically feasible and efficacious.