溶栓前肝素治疗对急性心肌梗死后左室重构的影响  

Influence on left ventricular remodeling of thrombolysis using heparin before administration of thrombolytic agent in patients with acute myocardial infarction

作　　者：陈金良[1] 傅向华[2] 马宁[2] 李显平[3] 刘保国[3] 柴锡庆[3] 

机构地区：[1]石家庄铁路分局邯郸铁路医院心内科,河北邯郸056001 [2]河北医科大学第二医院 [3]邯郸医专附属医院

出　　处：《中国危重病急救医学》2001年第3期164-166,共3页Chinese Critical Care Medicine

基　　金：河北省科委科研基金资助项目! ( No.冀卫科 980 16 2

摘　　要：目的 :探讨尿激酶 ( UK)溶栓前使用肝素对急性心肌梗死 ( AMI)后左室重构的影响。方法 :86例 AMI患者随机分为 2组 :早期肝素组在 U K溶栓之前静注肝素 ,对照组在 U K使用前不应用肝素。超声测定左室收缩末期内径 ( L VSd)和容量 ( ESV)、舒张末期内径 ( L VDd)和容量 ( EDV) ,计算左室射血分数 ( EF)和室壁阶段运动积分 ( RWMI) ,比较 2组的左室重构情况。结果 :早期肝素组的 ESV和 EDV均明显低于对照组 ( P<0 .0 5或 P<0 .0 1) ,RWMI低于对照组 ( P<0 .0 5 ) ,EF高于对照组 ( P<0 .0 5 )。早期肝素组的下壁梗死组 ESV、EDV、RWMI和 EF与对照组比较无统计学差异 ,前壁梗死组的 ESV、EDV、RWMI均低于对照组 ( P<0 .0 1或P<0 .0 5 ) ,EF高于对照组 ( P<0 .0 1)。结论 :早期应用肝素辅助溶栓治疗 ,可改善左室重构 。Objective:To investigate the influence of a sequential usage of intravenous thrombolysis (prethrombolytic heparinurokinasepostthrombolytic heparin) on left ventricular remodeling and heart function in patients with acute myocardial infarction (AMI).Methods:Eightysix cases of AMI were randomly divided into two groups.Patients in group one ( n =48) received early intravenous administration of heparin and urokinase sequentially 〔namely heparinurokinasepostthrombolytic heparin (HUH)〕.Patients in control group ( n =38) were treated only by urokinase.The changes of echocardiography on left ventricular endsystolic volume and enddiastolic volume were compared.Results:The left ventricular endsystolic volume,enddiastolic volume and regional wall motion index (RWMI) in the HUH group were less than those in control group and the statistical difference was significant ( P <0 05 or P <0 01).The eject fraction of the anterior wall myocardial infarction in HUH group increased significantly more than that in control group ( P <0 05).However,there was no significance in cases of inferior wall myocardial infarction.Conclusions:The sequential usage of intravenous thrombolysis of heparinurokinaseheparin in patients with AMI can contribute to the left ventricular remodeling and improve the cardiac function.

关 键 词：急性心肌梗死 肝素 尿激酶 左室重构 治疗 

分 类 号：R542.22[医药卫生—心血管疾病]