标题：低分子肝素早期使用对急性心肌梗死患者溶栓效果的影响

      作者：张拥军 1，林奋强 1，卫玉光 2    (东莞市长安医院急诊科 1、药学部 2，广东 东莞 523305)

      卷次： 2018年29卷12期

      【摘要】 目的 探讨低分子肝素早期使用对急性心肌梗死患者溶栓效果的影响。方法 选择2015年1月至2017年8月期间东莞市长安医院急诊科收治的72例急性心肌梗死(AMI)患者为研究对象，根据随机数表法分为观察组(n=36)与对照组(n=36)，两组患者均予尿激酶静脉溶栓治疗，对照组常规在溶栓后12h应用低分子肝素，观察组则在溶栓前应用低分子肝素，疗程均为1周，比较两组患者血管再通情况、心电图ST-T段回落≥50%的时间、出血不良反应发生情况和病死率。两组患者在溶栓前及溶栓 12 h后，测定血清超敏C反应蛋白(hs-CRP)及白细胞介素-6 (IL-6)、肿瘤坏死因子-α (TNF-α)水平。结果 观察组患者的再通率为88.89%，明显高于对照组的69.44%，再通时间及ST-T段回落≥50%的时间分别为(1.47±0.62) h、(2.18±0.75) h，均明显短于对照组的(2.06±0.95) h、(2.69±1.08) h，差异均有统计学意义(P<0.05)；观察组治疗后的血清 hs-CRP、IL-6及TNF-α水平分别为(4.82±1.94) mg/L、(13.36±4.23) pg/mL、(23.22±4.63) pg/mL，明显低于对照组的(7.16±2.48) mg/L、(20.16±5.15) pg/mL、(30.65±6.74) pg/mL，差异均有统计学意义(P<0.05)；观察组患者的出血并发症发生率为13.89%，病死率为5.56%，分别与对照组的8.33%和8.33%比较，差异均无统计学意义(P>0.05)。结论 低分子肝素在急性心肌梗死患者溶栓治疗过程中早期应用可有效调节患者细胞炎症因子水平，提高再通率，缩短再通时间，且不增加出血风险。
      【关键词】 急性心肌梗死；低分子肝素；尿激酶；疗效；炎症因子
      【中图分类号】 R542.2+2 【文献标识码】 A 【文章编号】 1003—6350（2018）12—1639—03

Effect of early use of low-molecular-weight heparin on thrombolytic effect in patients with acute myocardialinfarction.
ZHANG Yong-jun 1, LIN Fen-qiang 1, WEI Yu-guang 2. Emergency Department 1, Faculty of PharmaceuticalSciences 2, Dongguan Changan Hospital, Dongguan 523305, Guangdong, CHINA
【Abstract】 Objective To investigate the effect of early use of low-molecular-weight heparin on thrombolyticeffect in patients with acute myocardial infarction. Methods A total of 72 patients of acute myocardial infarction(AMI) treated in Emergency Department of Dongguan Changan Hospital from January 2015 to August 2017, accordingto random number table, were selected and divided into observation group (n=36) and control group (n=36), whichwere all treated with intravenous thrombolytic therapy. The control group applied low-molecular-weight heparin 12 hafter thrombolysis, and the observation group used low-molecular-weight heparin before thrombolytic therapy, for oneweek. Vascular recanalization, time of ECG ST-T segment fall≥50%, bleeding adverse reactions, and mortality werecompared between the two groups. The levels of serum hypersensitive C reactive protein (hs-CRP), interleukin-6(IL-6), and tumor necrosis factor-α (TNF-α) were measured in the two groups before and after (12 h) thrombolytictherapy. Results The recanalization rate (88.89%) in the observation group was significantly higher than 69.44% in thecontrol group. The recanalization time and time of ST-T segment fall≥50% were (1.47±0.62) h and (2.18±0.75) h, signif-icantly shorter than (2.06±0.95) h and (2.69±1.08) h in the control group (P<0.05). The hs-CRP, IL-6 and TNF-α in theobservation group were (4.82±1.94) mg/L, (13.36±4.23) pg/mL and (23.22±4.63) pg/mL respectively, which were signifi-cantly lower than (7.16±2.48) mg/L, (20.16±5.15) pg/mL and (30.65±6.74) pg/mL in the control group (P<0.05). Thecomplication rate (13.89%) and mortality (5.56%) in observation group and control group (8.33% and 8.33%) showed nostatistically significant difference (P>0.05). Conclusion Early application of low-molecular-weight heparin in thrombo-lytic therapy for acute myocardial infarction patients can effectively regulate the level of inflammatory cytokines, im-prove the recanalization rate, shorten the recanalization time, and not increase the risk of bleeding.
      【Key words】 Acute myocardial infarction; Low-molecular-weight heparin; Urokinase; Curative effect; Inflamma-tory factors·论 著·doi:10.3969/j.issn.1003-6350.2018.12.004