非ST段抬高急性冠状动脉综合征急诊冠状动脉介入治疗中达肝素与普通肝素的随机对照研究  

Randomized comparative study of using dalteparin or unfractionated heparin adjunctive to emergency percutaneous coronary intervention in patients with non ST-segment elevation acute coronary syndrome

作　　者：于海初[1] 孙桂霞[1] 王永彬[1] 郭明磊[1] 申方[1] 王少春[1] 尹磊[1] 周长勇[1] 贾秀玲[1] 姜艳[1] 王淑娟[1] 邢珂[1] 

机构地区：[1]青岛大学医学院附属医院急诊医学中心,山东青岛266003

出　　处：《临床荟萃》2008年第15期1071-1073,共3页Clinical Focus

摘　　要：目的前瞻性地评价高危非ST段抬高急性冠状动脉综合征患者，接受急诊冠状动脉介入治疗（PCI）中应用迭肝素的安全性和有效性。方法选择高危非ST段抬高急性冠状动脉综合征患者175例，随机分为迭肝素组和普通肝素组；达肝素组于确诊后尽早给予达肝素5000U，1次皮下注射，急诊PCI手术前追加迭肝素60U／kg，静脉注射，完成冠状动脉造影或急诊PCI后，立即拔出鞘管；普通肝素组于手术前即刻先给予普通肝素25mg，静脉注射，如果造影显示适合经皮冠状动脉腔内成形术（PTCA），再追加65mg；完成PCI后4～6小时拔出鞘管；迭肝素组部分患者测定抗Xa因子活性。结果迭肝素组83例患者完成PCI手术，普通肝素组82例患者完成PCI手术；迭肝素组52例患者进行了抗Xa活性测定，静脉注射迭肝素后15分钟，平均抗Xa因子活性（0．83士0．26）U／ml，96．1％的患者抗Xa活性〉0．5U／ml；迭肝素组穿刺部位血肿较普通肝素组明显减少（2．3％VS9．2％，P〈0．05）；两组患者无1例出现严重出血事件。PCI术后30天无死亡、无急性冠状动脉再闲塞或急诊血管重建事件。结论本研究初步表明，对拟行急诊PCI的高危非ST段抬高急性冠状动脉综合征患者于确诊后尽早给予迭肝素5000U皮下注射，PCI手术前追加迭肝素60U／kg静脉注射是安全、有效的，术后可即刻拔出鞘管。Objective To investigate the safety and efficacy of using dalteparin instead of unfraetionated heparin （UFH） in non-ST-segment elevation acute coronary syndrome patients undergoing emergency pereutaneous coronary intervention（PCI） procedures. Methods A total of 175 non-ST-segment elevation acute coronary syndrome patients with high TIMI risk score undergoing emergency PCI were randomized to administer dalteparin （5000 U, subcutaneous injection,once at earliest point of care, 60 U/kg, iv, before coronary angiogram and the sheath was withdrawn immediately after the procedure, n ： 88） or UFH （25 mg,iv, before coronary angiogram with additional 65 mg if PCI indicated and the sheath was withdrawn 4 to 6 hours after the procedure, n ： 87）. Blood samples were taken for further measurement of the anti- X a activity in dalteparin group. Results Plasma anti- X a factor activity was （0.83 ± 0.26） U/ml at the time 15 rain after dalteparin intravenous administration. 96.1 % of the average anti-X a activity value was〉 0.5 U/ml in dalteparin group. Hematoma at the puncture site happened in 2 patients （2.3%） in dalteparin group and 8 patients （9.2%） in UFH group（ P 〈0.05） . No major hemorrhage occurred. In 30-days follow up, no death, no recurrent acute myocardial infarction and no revaseularization occurred. Conclusion Dalteparin 5000 U subcutaneous injection at earliest point of care, supplemental Ⅳ dalteparin （60 U/kg） before coronary angiogram instead of UFH seems to be safe and effective in non-ST-segment elevation acute coronary syndrome patients undergoing emergency PCI. And the sheath can be withdrawn immediately after the procedure.

关 键 词：冠状动脉疾病 迭肝素 血管成形术 经腔 经皮冠状动脉 

分 类 号：R54[医药卫生—心血管疾病]