急性ST段抬高型心肌梗死直接PCI的依诺肝素应用  

ENOXAPARIN(CLEXANE) FOR ACUTE MYOCARDIAL INFARCTION WITH ST-SEGMENT ELEVATION PATIENTS UNDERGOING PRIMARY PERCUTANEOUS CORONARY INTERVENTION

作　　者：于海初[1] 孙桂霞[1] 王永彬[1] 郭明磊[1] 申方[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：《青岛大学医学院学报》2008年第5期421-423,共3页Acta Academiae Medicinae Qingdao Universitatis

摘　　要：目的探讨急性ST段抬高型心肌梗死病人接受直接经皮冠状动脉造影和介入治疗（PCI）中应用依诺肝素替代普通肝素的安全性和有效性。方法将急性ST段抬高型心肌梗死病人281例随机分为依诺肝素组（n=140）和普通肝素组（n=141），依诺肝素组病人于确诊后尽早给予依诺肝素1mg／kg皮下注射，PCI前追加依诺肝素0．3mg／kg静脉注射，完成冠状动脉造影或直接PCI后，立即拔出鞘管。普通肝素组病人于手术前给予普通肝素25mg静脉推注，如果造影显示适合PTCA，再追加65mg。完成PCI后4-6h拔出鞘管。依诺肝素组72例病人术后10、60min测定抗Xa因子活性。随访30d，观察两组死亡、再发心肌梗死及需行血管再通术等不良事件的发生情况。结果依诺肝素组和普通肝素组中最终行直接PCI者分别为139例和138例。依诺肝素组1例于PTCA后发生无血流，血栓负荷重，使用血栓抽吸导管抽吸血栓后血流改善，成功行支架植入术。两组PCI术后及住院期间均无急性和亚急性血栓形成。依诺肝素组病人静脉注射依诺肝素后10min抗Xa因子活性为（0．92±0．31）kU／L，60min为（0.81±0．29）kU／L，PCI术中97．9％的病人抗Xd活性〉0．5kU／L。依诺肝素组均于术后即刻拔出鞘管，穿刺部位血肿1例；普通肝素组于术后4-6h拔出鞘管，穿刺部位血肿7例，两组比较差异有统计学意义（x^2=4．588，P〈0.05）。两组30d内均未发生死亡、再发心肌梗死及需行血管再通术等临床事件。结论对拟行直接PCI的急性ST段抬高型心肌梗死病人应用依诺肝素替代普通肝素静脉注射是安全、有效的，术后可即刻拔出鞘管。Objective To investigate the safety and efficacy of using enoxaparin instead of common heparin in acute STE-MI patients undergoing primary PCI. Methods A total of 281 patients with acute STEMI undergoing primary PCI were randomized to enoxaparin group （n=140） and heparin group （n= 141）. For enoxaparin group： enoxaparin, 1 mg/kg, hypodermic, once diagnosis confirmed, and a boost of 0.3 mg/kg, iv, before PCI, the sheath was withdrawn immediately after the procedure; for heparin group： 25 mg, iv, before coronary angiography, if PCI was indicated, an additional 65 mg was given, the sheath was then withdrawn four to six hours after the procedure. Results In 277 patients received primary PCI, 139 in enoxaparin group and 138 in heparin group. One patient in enoxaparin group developed no-reflow after PTCA and revaseularization was achieved. No major adverse cardiac events were encountered in both groups. The Anti-X a activities in enoxaparin group at 10 and 60 min after the injection of enoxaparin were （0.92±0.31） kU/L and （0.81±0.29） kU/L, respectively, and the Anti-X a activity of 97.9% patients was 〉0.5 kU/L during PCI. Hematoma at puncture site occurred in one patient （0.71%） in enoxaparin group and seven patients （4.9%,P〈0.05） in heparin group. Within 30 days of follow-up, no death, no recurrence and no revaseularization required were noted in both groups. Conclusion For acute STEMI patients planning to have a primary PCI, using enoxaparin to replace heparin is safe and effective, and the sheathe can be removed immediately after the procedure.

关 键 词：依诺肝素 血管成形术 经腔 经皮冠状动脉 冠状动脉疾病 

分 类 号：R542.22[医药卫生—心血管疾病]