依诺肝素与普通肝素联合重组组织纤溶酶原激活剂溶栓治疗ST段抬高的急性心肌梗死的研究  

Study of enoxaparin and general heparin combined with recombinant tissue plasminogen activators thrombolysis on acute myocardial infarction patients with ST segment elevation

作　　者：蒋建东[1] 蒋超旦[1] 杨松[1] 

机构地区：[1]江苏大学附属宜兴医院,江苏宜兴214200

出　　处：《现代中西医结合杂志》2010年第29期3692-3694,共3页Modern Journal of Integrated Traditional Chinese and Western Medicine

摘　　要：目的比较依诺肝素与普通肝素在ST段抬高的急性心肌梗死(STEMI)重组组织纤溶酶原激活剂(rt-PA)溶栓时应用的疗效及安全性。方法 91例STEMI患者随机分成2组:治疗组46例予rt-PA溶栓联合依诺肝素,对照组45例予rt-PA溶栓联合普通肝素。观察溶栓开始后60 min及120 min梗死相关血管再通率、治疗中出血并发症及30 d左心室射血分数(LVEF)。结果溶栓开始后60 min治疗组血管再通率显著高于对照组,溶栓开始后90 min治疗组与对照组的血管再通率比较无显著性差异。治疗组与对照组30 d内梗死后心绞痛、再梗死、死亡率、中风、需要血运重建无显著性差异。治疗组30 d LVEF显著高于对照组。出血发生率治疗组与对照组比较无显著性差异。结论与普通肝素比较,依诺肝素联合rt-PA静脉溶栓治疗STEMI患者安全有效,能更早开通梗死相关血管,改善左心室功能,不增加出血并发症。Objective It is to compare the curative effect and safety of enoxaparin and general heparin combined with recombinant tissue plasminogen activators（rt-PA） thrombolysis on acute myocardial infarction patients with ST segment elevation（STEMI）.Methods 91 STEMI patients were randomly divided into two groups.46 cases were in treatment group and treated with rt-PA thrombolysis combined with enoxaparin.The other 45 cases were in control group and treated with rt-PA thrombolysis combined with general heparin.The infarct correlative revascularization rate after thrombolysis for 60 min and 120 min,bleeding complication in treatment and 30 d left ventricular ejection fraction（LVEF） in the two groups were observed.Results The infarct correlative revascularization rate after thrombolysis for 60 min in treatment group was significantly higher than that in control group.There was no significant difference on the infarct correlative revascularization rate after thrombolysis for 120 min between the two groups.There were no significant differences on postinfarctional angina pectoris in 30 days,re-infarct,mortality,stroke and needing revascularization between the two groups.The 30 d LVEF in treatment group was significantly higher than that in control group.There was no significant difference on the bleeding incidence rate between the two groups.Conclusion Compared with general heparin,enoxaparin combined with rt-PA thrombolysis on AMI patients is safe and effective,and can early open infarct correlative revascularization,improve left ventricular function and not increase bleeding complication.

关 键 词：ST段抬高 急性心肌梗死 血栓溶解疗法 依诺肝素 组织纤溶酶原激活剂 

分 类 号：R054.222[医药卫生]