摘要
目的对比分析ST段抬高型心肌梗死(STEMI)患者普佑克溶栓治疗前后应用肝素的临床效果。方法抽取河津市人民医院2019年2月至2021年5月收治的STEMI患者152例为研究对象,按照随机数字表法分为对照组与观察组,每组76例。两组均给予普佑克溶栓治疗,观察组患者于溶栓前给予肝素,对照组于溶栓后给予肝素。比较两组血管再通情况、凝血指标[活化部分凝血活酶原时间(APTT)、血浆凝血酶原时间(PT)、激活全血凝血时间(ACT)]、出血并发症发生率、随访1个月主要心血管不良事件发生率。结果观察组冠状动脉再通率(88.16%,67/76)高于对照组(73.68%,56/76),再通时间、ST-T段回落≥50%的时间短于对照组(P<0.05)。观察组溶栓后6 h、溶栓后1 d、溶栓后3 d时,APTT、PT、ACT水平均高于对照组(P<0.05);两组溶栓后7 d时APTT、PT、ACT水平比较差异未见统计学意义(P>0.05)。溶栓后1周,观察组出血并发症发生率(13.16%,10/76)高于对照组(3.95%,3/76),差异有统计学意义(P<0.05)。溶栓后随访1个月,两组主要心血管不良事件发生率比较差异未见统计学意义(P>0.05)。结论采用普佑克溶栓治疗的STEMI患者早期应用肝素可有效提高其血管再通率并缩短再通时间,加强抑制凝血效果,但也增加了出血风险。
Objective To compare and analyze the effects of heparin therapy before and after prourokinase thrombolysis on patients with ST-segment elevation myocardial infarction(STEMI).Methods A total of 152 patients with STEMI treated in Hejin People’s Hospital from February 2019 to May 2021 were selected as research objects.And they were divided into control group and observation group by random number table method,with 76 patients in each group.All selected patients underwent prourokinase thrombolysis.Patients in observation group were given heparin before thrombolysis,while patients in control group were given heparin after thrombolysis.The revascularization,coagulation indexes,including activated partial thromboplastin time(APTT),plasma prothrombin time(PT),activated blood clotting time(ACT),incidence of bleeding complications,and incidence of major adverse cardiovascular events during 1-month follow-up were compared between the two groups.Results The coronary recanalization rate in observation group(88.16%,67/76)was higher than that in control group(73.68%,56/76),while recanalization time and spending time of ST-T segment fall≥50%were shorter than those in control group(P<0.05).At 6 h,1 d and 3 d after thrombolysis,levels of APTT,PT and ACT in observation group were higher than those in control group(P<0.05).At 7 d after thrombolysis,difference in levels of APTT,PT and ACT between the two groups was not statistically significant(P>0.05).At 1 week after thrombolysis,incidence of bleeding complications in observation group(13.16%,10/76)was higher than that in control group(3.95%,3/76),P<0.05.There was no significant difference in incidence of major adverse cardiovascular events between the two groups during 1-month follow-up(P>0.05).Conclusions Early usage of heparin can effectively increase revascularization rate,shorten recanalization time,and strengthen inhibitory effect of coagulation in patients with STEMI undergoing prourokinase thrombolysis.However,it also increases bleeding risk.
作者
赵康民
Zhao Kangmin(Departent of Emergency Medicine,Hejin People’s Hospital,Hejin 043300,China)
出处
《中国实用医刊》
2022年第4期97-100,共4页
Chinese Journal of Practical Medicine
关键词
ST段抬高型心肌梗死
溶栓
肝素
血管再通率
心肌损伤
ST-segment elevation myocardial infarction
Thrombolysis
Heparin
Revascularization rate
Myocardial injury
