CAJ | 학술논문

目的比较磺达肝癸钠和低分子肝素钙对急性非ST段抬高型心肌梗死（NSTEMI）的临床疗效及安全性。方法纳入2011年10月～2013年3月间急性NSTEMI患者120例，随机分为对照组（n=56）和治疗组（n=64），所有患者均接受常规药物治疗，控制血压、血糖，对照组予低分子肝素钙0.1 ml/10 kg皮下注射（q12 h），连用7 d；治疗组给予磺达肝癸钠2.5 mg/d皮下注射（qd），连用7 d。于基线和首次给药2 h后检测血栓弹力图（thrombelastography，TEG），同时观察治疗7 d及30 d后主要不良心血管事件（MACE，包括再发心绞痛、再发心肌梗死、死亡、恶性心律失常）发生率及出血率。结果对照组与治疗组基线血栓弹力图反应时间（TEG-R，5.25 min vs.4.98 min）和治疗2 h后的TEG-R（11.05 min vs.13.40 min）均无统计学差异（P＞0.05）。治疗过程中对照组和治疗组MACE发生率无统计学差异（7 d：21.43%vs.6.25%；30 d：21.43%vs.9.38%；P均＞0.05）。治疗7 d后，两组严重出血发生率无统计学差异（5.36%vs.1.56%），但治疗组轻度出血发生率较对照组明显减少（3.13%vs.23.21%，P＜0.05）；治疗30 d后，治疗组严重出血（0 vs.7.14%）和轻度出血（4.69%vs.26.79%）发生率较对照组显著降低，两组差异有统计学意义（P＜0.05）。结论磺达肝癸钠与低分子肝素钙治疗NSTEMI同等有效且安全性更佳。
목적비교광체간계납화저분자간소개대급성비ST단태고형심기경사（NSTEMI）적림상료효급안전성。방법납입2011년10월～2013년3월간급성NSTEMI환자120례，수궤분위대조조（n=56）화치료조（n=64），소유환자균접수상규약물치료，공제혈압、혈당，대조조여저분자간소개0.1 ml/10 kg피하주사（q12 h），련용7 d；치료조급여광체간계납2.5 mg/d피하주사（qd），련용7 d。우기선화수차급약2 h후검측혈전탄력도（thrombelastography，TEG），동시관찰치료7 d급30 d후주요불양심혈관사건（MACE，포괄재발심교통、재발심기경사、사망、악성심률실상）발생솔급출혈솔。결과대조조여치료조기선혈전탄력도반응시간（TEG-R，5.25 min vs.4.98 min）화치료2 h후적TEG-R（11.05 min vs.13.40 min）균무통계학차이（P＞0.05）。치료과정중대조조화치료조MACE발생솔무통계학차이（7 d：21.43%vs.6.25%；30 d：21.43%vs.9.38%；P균＞0.05）。치료7 d후，량조엄중출혈발생솔무통계학차이（5.36%vs.1.56%），단치료조경도출혈발생솔교대조조명현감소（3.13%vs.23.21%，P＜0.05）；치료30 d후，치료조엄중출혈（0 vs.7.14%）화경도출혈（4.69%vs.26.79%）발생솔교대조조현저강저，량조차이유통계학의의（P＜0.05）。결론광체간계납여저분자간소개치료NSTEMI동등유효차안전성경가。
Objective To study and compare the curative effects and safety of fondaparinux and low-molecular-weight heparin calcium in treatment of non-ST-segment elevation myocardial infarction (NSTEMI). Methods The patients (n=120) with NSTEMI were chosen from Oct. 2011 to Mar. 2013, and then randomly divided into control group (n=56) and treatment group (n=64). All patients were given retuin therapy to control blood pressure and blood sugar. The control group was then given hypodermic injection of low-molecular-weight heparin calcium (0.1 mL/10 kg) for 7 days and treatment group, fondaparinux (2.5 mg/d) for 7 days. The changes of thrombelastography (TEG) were detected at baseline and after treatment for 2 hours, meanwhile the incidence of major adverse cardiovascular events (MACE, relapse angina, relapse myocardial infarction, death and malignant arrhythmia) and bleeding were observed in two groups. Results There was no significant difference in TEG-R between two groups (P>0.05) both at baseline (4.98 min vs. 5.25 min) and after 2 hours (13.40 min vs. 11.05 min). The incidence of MACE had no statistical difference between two groups during the treatment (7 d:21.43%vs. 6.25%;30 d:21.43%vs. 9.38%;all P>0.05). After treatment for 7 days, the incidence of severe bleeding had no statistical difference between two groups (5.36%vs. 1.56%), while that of mild bleeding decreased significantly in treatment group compared with control group (3.13%vs. 23.21%, P<0.05). After treatment for 30 days, the incidences of severe bleeding (0 vs. 7.14%) and mile bleeding (4.69%vs. 26.79%) decreased significantly in treatment group compared with control group (P<0.05). Conclusion Fondaparinux has the same curative effect and higher safety in the treatment of NSTEMI compared with low-molecular-weight heparin calcium.