CAJ | 학술논문

目的：：探讨急性ST段抬高型心肌梗死患者行直接经皮冠状动脉介入治疗（PCI）术中应用依诺肝素加小剂量普通肝素盐水冲管治疗的安全性和有效性。方法：入选我院2011.3-2014.08收治的急性ST段抬高型心肌梗死患者137例，随机分为依诺肝素加小剂量普通肝素盐水冲管治疗组（A组 n=52）和依诺肝素组（B组 n=41），普通肝素组（C组 n=44）。A、B组患者于确诊后予依诺肝素0.5mg/kg静脉注射，A组术中通过三联三通应用普通肝素盐水（600u/h）持续冲洗导管。C组患者于PCI手术前给予普通肝素75-100u/kg静脉注射。其他基础治疗方案相同，随访30天，观察三组死亡、再发心肌梗死及导管内接触性血栓等不良事件的发生及出血发生情况。结果：三组患者30天内均未发生死亡，三组患者30天内再发心肌梗死分别为A组0例，B组0例，C组1例，（A vs B，P＞0.05 B vs C，P＜0.05 A vs C，P＜0.05）。导管内接触性血栓发生率A组1例，B组3例，C组1例，（A vs B，P＜0.05 B vs C，P＜0.05 A vs C，P＞0.05）。三组患者均无TIMI严重出血发生，TIMI轻微出血发生率分别为A组1例1.9%，B组1例2.4%，C组1例2.2%，三组间无显著性差异。结论本研究提示在STEMI患者行直接经皮冠状动脉介入治疗术中应用依诺肝素加小剂量普通肝素盐水冲管治疗是安全及有效的。
목적：：탐토급성ST단태고형심기경사환자행직접경피관상동맥개입치료（PCI）술중응용의낙간소가소제량보통간소염수충관치료적안전성화유효성。방법：입선아원2011.3-2014.08수치적급성ST단태고형심기경사환자137례，수궤분위의낙간소가소제량보통간소염수충관치료조（A조 n=52）화의낙간소조（B조 n=41），보통간소조（C조 n=44）。A、B조환자우학진후여의낙간소0.5mg/kg정맥주사，A조술중통과삼련삼통응용보통간소염수（600u/h）지속충세도관。C조환자우PCI수술전급여보통간소75-100u/kg정맥주사。기타기출치료방안상동，수방30천，관찰삼조사망、재발심기경사급도관내접촉성혈전등불량사건적발생급출혈발생정황。결과：삼조환자30천내균미발생사망，삼조환자30천내재발심기경사분별위A조0례，B조0례，C조1례，（A vs B，P＞0.05 B vs C，P＜0.05 A vs C，P＜0.05）。도관내접촉성혈전발생솔A조1례，B조3례，C조1례，（A vs B，P＜0.05 B vs C，P＜0.05 A vs C，P＞0.05）。삼조환자균무TIMI엄중출혈발생，TIMI경미출혈발생솔분별위A조1례1.9%，B조1례2.4%，C조1례2.2%，삼조간무현저성차이。결론본연구제시재STEMI환자행직접경피관상동맥개입치료술중응용의낙간소가소제량보통간소염수충관치료시안전급유효적。
Objective The purpose of the study is to investigate the safety and efficacy of anticoagulation with enoxaparin plus low-dose unfractionated heparin in acute ST segment elevation myocardial infarction(STEMI) patients undergoing primary percutaneous coronary intervention. Methods 137 patients with acute STEMI were divided into three groups according to different anticoagulant therapy approache during the procedure:enoxaparin plus low-dose unfractionated heparin (group A n=52),treatment with enoxaparin (group B n=41), treatment with unfractionated heparin(group C n=44). After diagnosis confirmed,group A and B received intravenous injection enoxaparin(0.5mg/kg) immediately.Group A treated with low-dose unfractionated heparin saline flush the catheter consistently(600u/h)during the procedure.Group C were given unfractionated heparin before PCI procedure(75-100u/kg). There was no difference in basement therapy between three groups.During 30days fol ow-up,death,reinfarction, the incidence of catheter directed thrombolysis and bleeding events were observed.Results During fol ow-up within 30 days, no death occurred in al patients.No reinfarction during 30days fol ow-up were observed in group A and B,in group C,one patient occurred reinfarction on the third day after procedure(A vs B,P>0.05 B vs C,P<0.05 A vs C,P<0.05).The incidence of catheter directed thrombolysis were observed:one case in group A,three cases in group B and one case in group C(A vs B,P<0.05 B vs C,P<0.05 A vs C,P>0.05).The bleeding incidence has no statistical differences in three groups.Conclusion The anticoagulation with enoxaparin plus low-dose unfractionated heparin were proved to be effective and safety in STEMI patients undergoing PCI procedure in this study.