早期肝素化对急性ST段抬高型心肌梗死患者直接经皮冠状动脉介入治疗的疗效

doi:10.3969/j.issn.1004-583X.2020.02.007

临床荟萃

早期肝素化对急性ST段抬高型心肌梗死患者直接经皮冠状动脉介入治疗的疗效

1.邯郸市中心医院心内五科，河北邯郸 056002；2.秦皇岛市海港医院心内科，河北秦皇岛 066000；
3.河北医科大学第二医院心内五科，河北石家庄 050051

出版日期:2020-02-20 发布日期:2020-03-24
通讯作者: 王海燕, Email: haiyanwang012@163.com

Effects of early heparin therapy on patients with acute STsegment elevation myocardial infarction undergoing primary percutaneous coronary intervention

1. Fifth Department of Cardiology, Handan Central Hospital, Handan 056000, China;
2. Department of Cardiology, Qinhuangdao Haigang Hospital, Qinhuangdao 066000, China;
3. Fifth Department of Cardiology, the Second Hospital of Hebei Medical University,
Shijiazhuang 050051, China

Online:2020-02-20 Published:2020-03-24
Contact: Corresponding author: Wang Haiyan, Email: haiyanwang012@163.com

摘要/Abstract

摘要： 目的探究直接经皮冠状动脉介入术前(primary percutaneous coronary intervention, pPCI)肝素化对ST段抬高型心肌梗死（STsegment elevation myocardial infarction, STEMI）患者的影响。方法连续入选STEMI患者117例，随机分为观察组和对照组，观察组确诊为STEMI后立即静脉注射普通肝素5 000 U，对照组于术中给予普通肝素5 000 U。观察肝素启动时间、PCI前活化的凝血时间(activated coagulation time, ACT)、心肌损伤标志物峰值、心肌微循环阻力指数(index of microcirculation resistance, IMR)、其他心肌灌注评估指标。记录术后主要不良事件（major adverse events, MAES）。结果与对照组比较，观察组肝素给予的时间明显提前（约28 min），术前ACT明显延长(P=0.000)，血栓负荷率低（25.00% vs 43.90%, P=0.032）；造影即刻梗死相关动脉(IRA)的TIMI血流0~1级率低（45.00% vs 68.40%，P=0.011），TIMI心肌灌注分级(TMPG) 3级率高（75.30% vs 56.10%，P=0.032），IMR较低（P=0.007），心肌损伤标志物CKMB峰值低（P=0.007），心肌灌注缺损面积(perfusion defect area, PDA) 较低（P=0.031）。结论 pPCI术前早期肝素化提高了IRA的开通率，缩短心肌总缺血时间，缩小心肌梗死面积，改善心肌灌注，不增加MAES的风险。

关键词: 冠状动脉疾病, 肝素, 血管成形术, , 经腔, , 经皮冠状动脉, 心绞痛, , 不稳定型

Abstract: Objective To determine the effects of heparin therapy before primary percutaneous coronary intervention (pPCI) on patients with acute STsegment elevation myocardial infarction (STEMI). Methods A total of 117 STEMI patients were consecutively enrolled and randomly divided into observation group and control group. The STEMI patients of observation group were immediately given intravenous injection of 5 000 U unfractionated heparin, while those in control group received the same dose of unfractionated heparin during the surgery. The activation time of heparin, activated coagulation time (ACT) before PCI, peak value of myocardial injury markers, index of microcirculation resistance(IMR) of myocardia, and other evaluation indexes of myocardial perfusion were observed. Major adverse events (MAES) after the operation were also recorded. Results Compared with the control group, observation group had significantly earlier administration of heparin (about 28 min), longer ACT (P=0.000), and lower rate of high thrombus load (25.00% vs 43.90%, P=0.032); imagingready infarct related artery(IRA) TIMI flow rate 01 lower (45.00% vs 68.40%，P=0.011), higher rate of TIMI myocardial perfusion grading(TMPG) 3(75.30% vs 56.10%，P=0.032), lower IMR (P=0.007) lower peak value of CKMB(P=0.007), and smaller perfusion defect area(PDA) (P=0.031). Conclusion Early heparin therapy before pPCI can improve IRA opening, reduce total myocardial ischemia time, and myocardial infarction area, and ameliorate myocardial perfusion. And it does not increase the risk of MAES.

Key words: coronary disease; , heparin;angioplasty, , transluminal, , percutaneous coronary, angina, unstable

王海燕1，田丽1，赵颖2，李知娟1，石建平1，傅向华3. 早期肝素化对急性ST段抬高型心肌梗死患者直接经皮冠状动脉介入治疗的疗效[J]. 临床荟萃, doi: 10.3969/j.issn.1004-583X.2020.02.007.

Wang Haiyan1, Tian Li1, Zhao Ying2, Li Zhijuan1, Shi Jianping1, Fu Xianghua3. Effects of early heparin therapy on patients with acute STsegment elevation myocardial infarction undergoing primary percutaneous coronary intervention[J]. Clinical Focus, doi: 10.3969/j.issn.1004-583X.2020.02.007.

导出引用管理器 EndNote|Ris|BibTeX

链接本文: https://huicui.hebmu.edu.cn/CN/10.3969/j.issn.1004-583X.2020.02.007

https://huicui.hebmu.edu.cn/CN/Y2020/V35/I2/134

[1]	黄宇玲, 张欣悦, 荣萍萍, 杨文琦, 曹新营, 邢彩耐, 王志军, 刘宁. Non-HDL-C/HDL-C和NHR与冠状动脉病变严重程度的相关性[J]. 临床荟萃, 2024, 39(2): 115-120.
[2]	邹子良, 余海, 王迪, 褚泰运, 李驹, 钱宝堂. 冠状动脉慢性完全闭塞病变介入治疗研究现状[J]. 临床荟萃, 2024, 39(1): 80-83.
[3]	李华, 陈建军, 未纪涛, 张旗. 血清胱抑素C水平与非阻塞性冠状动脉疾病的关系[J]. 临床荟萃, 2023, 38(9): 802-805.
[4]	苏晨蓓, 王富军. 糖尿病下肢动脉疾病介入治疗疗效的研究进展[J]. 临床荟萃, 2023, 38(6): 569-572.
[5]	闫海燕, 丁延魁, 郏红静, 王记远, 张学伟, 胡银杰, 楚骏杰, 胡红艳, 过高峰. 院前肝素化联合一包药与急性ST段抬高型心肌梗死患者血管再通的相关性[J]. 临床荟萃, 2023, 38(3): 232-236.
[6]	王家琦, 谢悦陶, 高曼, 宋学莲, 张飞飞, 党懿, 齐晓勇. 光学相干断层成像指导治疗变异型心绞痛1例并文献复习[J]. 临床荟萃, 2023, 38(10): 917-921.
[7]	王雅洁, 李剑明, 刘菁晶, 卢宇杰, 林文华. 非阻塞性冠状动脉疾病女性患者冠状动脉血流储备异常的预测因素[J]. 临床荟萃, 2022, 37(9): 791-795.
[8]	王家琦, 高曼, 张飞飞, 李英肖, 党懿, 齐晓勇. 中性粒细胞与淋巴细胞比值联合GRACE评分对急性STEMI患者PCI术后发生院内主要不良心血管事件的预测价值[J]. 临床荟萃, 2022, 37(5): 412-417.
[9]	朱隽, 刘悦, 陈淑霞, 王贤, 郑露妍, 谷剑. ApoB/ApoA1比值对不稳定型心绞痛患者冠脉病变程度的预测价值[J]. 临床荟萃, 2022, 37(5): 422-426.
[10]	尹惠阳, 蔺雪峰, 韩轩茂. 蛋白激酶B通路、乙酰肝素酶、NADPH氧化酶在心肌缺血再灌注损伤中的作用及相互关系的研究进展[J]. 临床荟萃, 2022, 37(5): 459-462.
[11]	王亚柱, 郭云飞, 司月乔, 刘超, 张英. 心外膜脂肪组织体积与原发性高血压合并冠心病的相关性[J]. 临床荟萃, 2021, 36(8): 699-703.
[12]	邓凯彬, 韩亮, 牛绍乾, 王海燕, 汪雁博, 傅阳, 王庆, 战洋, 傅向华. 新型冠状病毒肺炎防控形势下救治策略调整对急性ST段抬高型心肌梗死患者救治效果[J]. 临床荟萃, 2021, 36(7): 595-599.
[13]	刘慧卿, 金凤表, 李青联, 高宇, 侯瑞田. CTRP13与冠心病合并糖尿病相关性研究进展[J]. 临床荟萃, 2021, 36(7): 655-658.
[14]	史骏, 刘新兵, 白艳艳, 岳丹丹, 王晓青, 刘天华, 冯六六. 急性心肌梗死冠状动脉介入术后心肌微循环灌注障碍的影响因素及与乳酸关系[J]. 临床荟萃, 2021, 36(5): 402-407.
[15]	张小乐, 蔡肇栩, 谢丽妍, 梁龙清. 广东省肇庆地区冠心病患者CYP2C19基因多态性差异性分布[J]. 临床荟萃, 2021, 36(5): 408-411.

早期肝素化对急性ST段抬高型心肌梗死患者直接经皮冠状动脉介入治疗的疗效

Effects of early heparin therapy on patients with acute STsegment elevation myocardial infarction undergoing primary percutaneous coronary intervention

PDF (PC)

可视化

摘要/Abstract

引用本文

使用本文

参考文献

相关文章 15

编辑推荐

Metrics

本文评价