急性冠脉综合征应用低分子肝素与普通肝素后血清浓度变化的比较  

The change of the pharmacokinetics of Low molecular weight heparin and common heparin by subcutaneous injection on the cases suffered acute coronary syndrome

作　　者：吴小庆[1] 谢国强[1] 王强[1] 簿小萍[1] 蒋南强[1] 王春新[1] 

机构地区：[1]无锡市第一人民医院心内科,214002

出　　处：《国外医学（心血管疾病分册）》2002年第6期361-363,共3页

摘　　要：目的:了解低分子肝素与普通肝素皮下注射后药代动力学变化及与临床的关系。方法:急性冠脉综合征患者29例,其中14例患者接受肝素钠6250U,15例患者接受低分子肝素4100U(速避凝0.4m1)腹部皮下注射,注射前及注射后30min,1、2、4、8、12h测血浆肝素浓度(Hep),Xa因子浓度、凝血酶原时间(PT)、凝血酶时间(TT)、部分凝血酶原时间(APTT)、以及纤维蛋白原(FIB)。结果:肝素皮下注射后30min即可见到血浆中肝素浓度上升,作用高峰时间为4h,8h时基本恢复正常(P<0.01)。血浆肝素浓度从小于0.01U/ml上升至4h的0.11U/ml(平均)。同时PT、TT、APTT也同步上升。肝素与PT、TT、APTT的相关系数分别为0.49、0.723、0.708(P<0.01)。低分子肝素皮下注射后,血浆Xa因子浓度上升较为平稳,1h与8h时的Xa因子浓度无明显差异,12h时血浆中仍有一定浓度的Xa因子,于用药前相比P<0.05。但PT、TT、APTT基本不变,与血浆Xa因子无明显关系。结论:肝素皮下注射后,其药代动力学变化比较快,对凝血因子影响较大,但不稳定,低分子肝素皮下注射后,血浆中Xa因子的变化较为稳定,对凝血因子无明显影响。在皮下注射时应首选低分子肝素。To know the change of the pharmacokinetics of heparin and low molecular weight heparin (LMWH) injected by subcutaneous and the influence upon clinic. Methods: 14 cases accepted the treatment of heparin. 6250U and 15 cases accepted LWMH (4 100U) used by subcutaneous injection. Before and after injection 30 minute,lh,2h,4h,8h, and 12h,the concentrations of heparin and PT, TT, APTT and FIB were tested. Results: After 30 minutes of injection, the comcentration of heparin began to rise, it arrived it's peak at 4h and returned to normal at 8h(P<0.01). The concentration of heparin rose from <0.01 U/ml to 0. 11U/ml at 4h, the PT, TT, APTT, also rose synchronously. The coefficients of correlation were 0.49, 0.723, 0.708 respectively. The concentration of Xa factor went up very smoothly after injected LMWH, there was no obviously different from 1h to 8h, the concentration of Xa at 12h was lower than at 8h, but still higher than the concentration before injection. PT, TT, APTT didn't change from 1h to 12h, and they didn't correlate with Xa factor. Conclusion: After injecting heparin the concentration of heparin in plasma changed very quickly and was unstable. But the change of Xa factor was very smooth after injecting LMWH. So it is better to select LMWH than normal heparin.

关 键 词：急性冠脉综合征 低分子肝素 普通肝素 血清浓度 凝血因子 药代动力学 

分 类 号：R541.4[医药卫生—心血管疾病] R973.[医药卫生—内科学]