ST段抬高型急性心肌梗死溶栓治疗后不同抗凝治疗的临床观察

摘要/Abstract

摘要： 目的观察比较ST段抬高型急性心肌梗死溶栓治疗后普通肝素(UFH)和parnaparin(商品名新复先) 两种不同抗凝辅助治疗方法的疗效和安全性。方法 186名入院后接受溶栓治疗的ST段抬高型急性心肌梗死患者随机分为2组,UFH组及parnaparin组。UFH组在溶栓治疗后12h给予肝素100U/kg·b.w.静脉推注,续1000U/h静脉滴注,维持活化的部分凝血活酶时间为正常对照的1.5~2.0倍,连续3d后改为皮下注射7500U每12h1次,连续注射4d。parna-parin组在溶栓治疗后12 h给予parnaparin0.4ml皮下注射,每12 h1次,连续注射7d。主要观察终点:治疗2、7、14、30 d内发生心脏性或非心脏性死亡、再梗死、药物治疗疗效差而必须行急诊血运重建的三联终点事件(死亡、心肌再梗死、紧急血运重建术)。所有入选患者住院14d以上,随访至治疗后45d。结果随访45d内复合三联终点事件在par-naparin组明显下降(42.22% vs37.08%,P=0.03),出血事件(10.00% vs 3.13%,P=0.06)及血小板减少(3.33% vs 0,P=0.07)亦少于UFH组。结论做为ST段抬高型急性心肌梗死溶栓治疗后的辅助抗凝治疗,parnaparin较UFH至少在45d内更能减少心脏事件的再发生,更少发生出血事件和血小板减少。

Abstract: Objective To compare the efficacy and safety of unfractionated heparin with a low -molecular-weight heparin (par-naparin) in the management of anticoagulation fol lowing thrombolytic therapy for acute ST-segment elevation myocardial in-farctio n.Methods One hundred and eighty-six patients with acute ST-segment elevation m yocardial infarction undergoing thrombolytic therapy were randomly assigned to receive either unfractionated heparin (100 U/kg·b.w. intravenous bolus, 1000U/h continuous infusion for 3 days just 12h after thrombolysis to maintain the activated partial thromboplastin time at 1.5 to 2.0 times as normal, then subcut aneous 7500U every 12h for 4 days, n=90) or parnaparin (0.4ml subcutaneously every 12h for 7 days 12h after thrombolysis, n=96) in conjunction with routi ne therapy. The patients enrolled stayed in hospital for at least 14 days and were followed for 45 days after admission into the hospital.Results The composit e triple end-point (death, recurrent myocardial infarction, emergency revascula rization assessed at 2, 7, 14, 45 days) was significantly reduced in pa-tients receiving parnaparin(42.22% vs 37.08%, P=0.03).Compared with unfractionated he parin group, the incidences of hemorrhage (10.00% vs3.13%, P=0.06)and heparin -induced thrombocytopenia (3.33% vs 0, P=0.07) were also lower in par-naparin gro up.Conclusion Parnaprin is more effective in reducing composite cardiac events, hemorrhage and heparin-in-duced thrombocytopenia at least in 45 days as compare d with unfractionated heparin during anticoagulation following throm-bolytic the rapy for acute ST-segment elevation myocardial infarction.

中图分类号:

R542.22

张晔, 王旭开, 杨成明, 刘光耀. ST段抬高型急性心肌梗死溶栓治疗后不同抗凝治疗的临床观察[J]. 南方医科大学学报, 2004, 24(01): 81-84.

ZHANG Ye, WANG Xu-kai, YANG Cheng-ming. Use of unfractionated heparin and a low-molecular-weight heparin following thrombolytic therapy for acute ST-segment elevation myocardial infarction[J]. Journal of Southern Medical University, 2004, 24(01): 81-84.

参考文献

[1] 中华心血管病杂志编委会.急性心肌梗塞溶栓疗法参考方案[J].中华心血管杂志(Chin Cardiovasc J),1996,24(5):328-9.
[2] Ryan TJ,Antman EM,Brooks NH,et al. Update:ACC/AHA guidelines for the management of patients with acute myocardial infarction. A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Management of Acute Myocardial Infarction)[J]. J Am Coll Cardiol,1999,34(3):890-911.
[3] Fuster V,Badimon L,Badimon JJ,et al. The pathogenesis of coronary artery disease and the acute coronary syndromes[J]. N Engl J Med,1992,336(4):242-50.
[4] 刘东,唐斌,蒙善东,等.血液滤过在移植肾功能延迟恢复治疗中的应用[J].第一军医大学学报,2001,21(9):691-2.Liu D,Tang B,Meng SD,et al. Clinical study of hemofiltration in the treatment of delayed graft function[J]. J First Mil Med Univ/Di Yi Jun Yi Da Xue Xue Bao,2001,21(9):691-2.
[5] 刘志强,王力,刘俊.国产与进口低分子肝素在血液透析中抗凝作用的比较[J].第一军医大学学报,2002,22(10):942-3.Liu ZQ,Wang L,Liu J.Comparison ofanticoagulation efficacy and clinical safety between imported and domestically manufaciured low-molecular-weight heparin during hemodialysis[J].J First Mil Med Univ/Di Yi Jun Yi Da Xue Xue Bao,2002,22(10):942-3.
[6] 邵燕,章成国,孙炽津,等.颅内静脉系统血栓形成的早期诊断及治疗[J].第一军医大学学报,2003,23(2):184-6.Shao Y,Zhang CG,Sun ZJ,et al. Early diagnosis and treatment of intracranial venous thrombosis[J]. J First Mil Med Univ/Di Yi Jun Yi Da Xue Xue Bao,2003,23(2):1 84-6.
[7] 高玉琪,李志樑,丁明学.等.急性前壁心肌梗死急性期ST段抬高形态与近期预后的关系[J].第一军医大学学报,2002,22(2):156-8.Gao YQ,Li ZL,Ding MX,et al. Relation of the ST-segment elevation pattern in acute phase of anterior wall acute myocardial infarction to short-term proguosis[J]. J First Mil Med Univ/Di Yi Jun Yi Da Xue Xue Bao,2002.22(2):156-8.
[8] 迟东升,刘伊丽,王鹏,等.超声心动图观察左室肥厚对评价高血压心肌微血管病变的价值[J].第一军医大学学报,2003,23(7):702-5.Chi DS,Liu YL,Wang P,et al. Value of echocardiography for observing left ventricular hypertrophy in the diagnosis of myocardial microvascular damage in hypertensives[J]. J First Mil Med Univ/Di Yi Jun Yi Da Xue Xue Bao,2003,23(7):702-5.
[9] Hirsh J,Levine MN. Low molecular weight heparin[J]. Blood,1992,79(1):1-17.
[10] Fareed J,Hoppeusteadt DA. Pharmacology of low molecular weight heparins[J]. Semin Thromb Hemost,1996,22(Suppl 2):13-8.
[11] Weitz JI. Low-molecular-heparins[J]. N Engl J Med,1997:337(10):688-98.
[12] James JJ. Low molecular heparins and glycoprotein Ⅱ b/Ⅲ a antagonists[J]. J Interven Cardiol,2002,15(2):147-54.
[13] Cohen M,Antman EM,Gurfmkel E,et al. Impact ofenoxaparin low molecular weight heparin in patients with Q-wave myocardial infarction[J]. Am J Cardiol,2000,86(5):553-6.
[14] Baird SH,Menown BA,Mcbride SJ,et al. Randomized comparison of enoxaparin with unfracfionated heparin following fibrinolytic therapy for acute myocardial infarction[J]. Eur Heart J,2002,23(8):627-32.