直接经皮冠状动脉介入治疗术前早期肝素化在ST段抬高型心肌梗死患者中的应用研究  

Application of early heparinization in patients with ST-segment elevation myocardial infarction before primary percutaneous coronary intervention

作　　者：杨秀 雷梦杰 支广硕 周海立 杨彦立 李雅超 薛增明 Yang Xiu;Lei Mengjie;Zhi Guangshuo;Zhou Haili;Yang Yanli;Li Yachao;Xue Zengming(Department of Cardiology,Key Laboratory of Precision Treatment of Coronary Heart Disease,People's Hospital of Langfang City,Hebei Medical University,Langfang 065000,China;不详)

机构地区：[1]河北医科大学附属廊坊市人民医院心内科,廊坊市冠心病精准治疗重点实验室,廊坊065000

出　　处：《中国循证心血管医学杂志》2023年第8期941-945,共5页Chinese Journal of Evidence-Based Cardiovascular Medicine

基　　金：河北省科技计划自筹经费项目(182777166);廊坊市科技技术研究与发展计划自筹经费项目(2020013107)。

摘　　要：目的 探讨直接经皮冠状动脉介入治疗(PPCI)术前早期肝素化在ST段抬高型心肌梗死(STEMI)患者中的应用效果。方法 入选2018年1月至2019年12月于廊坊市人民医院胸痛中心行PPCI的STEMI患者548例。根据患者接受肝素治疗的时机分为早期肝素组(n=274)和晚期肝素组(n=274)。早期肝素组患者在急诊室明确诊断后立即给予3000 U普通肝素静脉注射,晚期肝素组患者在导管室置入动脉鞘管后经鞘管注入3000 U普通肝素。两组在完成冠状动脉造影(CAG)后如需介入治疗则以75~100 U/kg经鞘管补充肝素剂量。观察患者罪犯血管的TIMI血流、肌钙蛋白I(TnI)、N末端脑钠肽前体(NT-proBNP)、治疗后主要心脑血管不良事件(MACCEs)、出血事件的发生情况。结果 早期肝素组患者TIMI 2级比例(9.9%vs.6.6%)、TIMI3级比例(24.1%vs.11.7%)显著高于晚期肝素组,差异有统计学意义(P<0.05)。结论 早期肝素化可提高急性心肌梗死患者罪犯血管再通率,缩短血管开通时间,减少坏死心肌,改善预后,值得临床推广。Objective To investigate the application effect of early heparinization in patients with ST-segment elevation myocardial infarction(STEMI) before primary percutaneous coronary intervention(PPCI).Methods STEMI patients(n=548) undergone PPCI were chosen from People's Hospital of Langfang City from Jan.2018 to Dec.2019.All patients were divided,according to heparin treatment time,into early heparin group and late heparin group(each n=274).The early heparin group was given injection of unfractionated heparin(3000 U) immediately after definitive diagnosis in emergency room,and late heparin group was given unfractionated heparin(3000 U) after implanted arterial sheath in catheterization room.After coronary angiography(CAG),the patients in 2 groups were given supplementation of heparin(75~100 U/kg) via arterial sheath if intervention treatment was required.The indexes of TIMI blood flow of culprit vessel,cardiac troponin I(cTnI),N-terminal pro-brain natriuretic peptide(NT-proBNP),and incidence status of major adverse cardiovascular and cerebrovascular events(MACCE) and bleeding events were observed in 2 groups.Results The comparison between early heparin group and late heparin group,the percentage of patients with grade 2 of TIMI was(9.9% vs.6.6%) and that of patients with grade 3 of TIMI was(24.1% vs.11.7%,P<0.05).Conclusion Early heparinization can improve the recanalization rate of culprit vessel,shorten opening time of vessels,relieve myocardial necrosis and improve prognosis in patients with acute myocardial infarction,which is worthy of clinical promotion.

关 键 词：ST段抬高型心肌梗死 早期肝素化 直接经皮冠状动脉介入治疗 TIMI血流 

分 类 号：R542.22[医药卫生—心血管疾病]