CAJ | 학술논문

目的探讨小剂量尿激酶(UK)联合低分子肝素钙在心肺复苏中的疗效和安全性.方法将64例心脏骤停患者按随机数字表法分为治疗组和对照组,每组32例,两组均按《2005国际心肺复苏与心血管急救指南》进行心肺复苏,治疗组在心肺复苏早期使用UK20万U,30 min内静脉泵入,低分子肝素钙4100U皮下注射.观察两组自主循环恢复(ROSC)、存活＞24h及存活30 d情况,观察两组是否有出血或因出血致死情况.结果对照组ROSC率为34.4％(11/32),治疗组为62.5％ (20/32),两组ROSC率比较差异有统计学意义(P＜0.05)；对照组存活＞24h率为15.6％(5/32),治疗组为40.6％(13/32),两组存活＞24h率比较差异有统计学意义(P＜0.05)；对照组存活30 d率为6.2％(2/32),治疗组为25.0％ (8/32),两组存活30d率比较差异有统计学意义(P＜0.01).对照组未出现皮下出血或其他脏器出血情况,治疗组有1例在低分子肝素钙注射部位出现皮下局限性淤血.治疗组治疗前后纤维蛋白原比较差异有统计学意义(P＜0.01),而凝血酶原时间、血小板计数比较差异无统计学意义(P＞0.05).结论心肺复苏中使用小剂量UK和低分子肝素钙治疗安全、有效.
목적 탐토소제량뇨격매(UK)연합저분자간소개재심폐복소중적료효화안전성.방법 장64례심장취정환자안수궤수자표법분위치료조화대조조,매조32례,량조균안《2005국제심폐복소여심혈관급구지남》진행심폐복소,치료조재심폐복소조기사용UK20만U,30 min내정맥빙입,저분자간소개4100U피하주사.관찰량조자주순배회복(ROSC)、존활＞24h급존활30 d정황,관찰량조시부유출혈혹인출혈치사정황.결과 대조조ROSC솔위34.4％(11/32),치료조위62.5％ (20/32),량조ROSC솔비교차이유통계학의의(P＜0.05)；대조조존활＞24h솔위15.6％(5/32),치료조위40.6％(13/32),량조존활＞24h솔비교차이유통계학의의(P＜0.05)；대조조존활30 d솔위6.2％(2/32),치료조위25.0％ (8/32),량조존활30d솔비교차이유통계학의의(P＜0.01).대조조미출현피하출혈혹기타장기출혈정황,치료조유1례재저분자간소개주사부위출현피하국한성어혈.치료조치료전후섬유단백원비교차이유통계학의의(P＜0.01),이응혈매원시간、혈소판계수비교차이무통계학의의(P＞0.05).결론 심폐복소중사용소제량UK화저분자간소개치료안전、유효.
Objective To study the curative effect and safety of low dose of urokinase (UK) combined with low molecular heparin calcium.Methods Sixty-four cases of sudden cardiac arrest patients were divided into treatment group and control group by random digits table with 32 cases each.Two groups were given cardiopulmonary resuscitation according to the 2005 international guide for cardiopulmonary resuscitation and emergency cardiovascular care.Early in the recovery,the patients in treatment group were pumped in vein with low dose of UK (200 000 U) and injected subcutaneous with low molecular heparin calcium (4100 U ) in 30 minutes.The rate of return of spontaneous circulation (ROSC),survival rate longer than 24 hours and 30 days in two groups and patients dying of bleeding or bleeding conditions in treatment group were observed.Results There were 11 cases (34.4％) of ROSC in control group,and compared with 20 cases (62.5％) in treatment group,there was significant difference (P＜0.05).There were 5 cases (15.6％) of survival longer than 24 hours in control group,and compared with 13 cases(40.6％) in treatment group,there was significant difference (P ＜ 0.05 ).There were 2 cases (6.2％) of survival 30 days in control group,and compared with 8 cases (25.0％) in treatment group,there was significant difference (P＜ 0.01 ).Nobody had subcutaneous bleeding or other organ hemorrhage in control group.But there was I patient who had subcutaneous limited ecchymosis in the injection site in treatment group.The difference of fibrinogen before and after treatment in treatment group was statistically significant (P ＜ 0.01 ),but there was no significant difference in prothrombin time and platelet count before and after treatment in treatment group (P ＞ 0.05).Conclusions It is safe and effective in cardiopulmonary resuscitation with low dose of UK combined with low molecular heparin calcium.