院前抗凝治疗对ST段抬高心肌梗死患者预后影响分析

doi:10.3969/j.issn.1006-6233.2017.04.025

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摘要 目的: 观察院前抗凝治疗对ST段抬高心肌梗死患者预后的影响。方法: 选取我院我院自2014年3月至2016年2月急诊收治的ST段抬高的急性心肌梗死患者56例,随机分为观察组(院前抗凝治疗)与对照组(常规处置),每组各28例,评价两组患者院前及入院后抢救结果,对比治疗后血浆人组织纤溶酶原激活物(t-PA)、人纤溶酶原激活剂抑制物(PAI-1)表达水平,记录近期心血管事件及不良反应发生情况。结果: 观察组院前抢救有效率为96.43%,对照组院前抢救有效率为92.86%(χ²=0.35,P=0.55);观察组入院后抢救有效率为92.86%,对照组患者入院后抢救有效率为92.86%(χ²=0,P=1.00)。病情平稳后,观察组患者t-PA表达水平高于对照组(t=3.53,P=0.00095),PAI-1表达水平低于对照组(t=2.51,P=0.016)。两组患者胃肠道不适(χ²=0.09,P=0.76)、瘀斑(χ²=0.12,P=0.73)及消化道出血(χ²=0.18,P=0.67)发病率差异具有统计学意义。观察组患者近期心血管事件发生率为12.00%,低于对照组的41.67%(χ²=5.53,P=0.019)。结论: 院前抗血小板治疗能够降低ST段抬高心肌梗死患者近期心血管事件发生率,改善患者纤溶失衡状态,同时不增加患者不良反应,值得临床推广应用。

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	范从华

关键词 ：院前, 抗凝, ST段抬高心肌梗死, 纤溶系统, 预后

Abstract：Objective: To observe the effect of pre-hospital antiplatelet therapy on the prognosis of patients with myocardial infarction with ST-segment elevation. Methords: 56 patients with ST-segment elevation acute myocardial infarction admitted to our hospital from March 2014 to February 2016 were randomly divided into observation group (pretreated anticoagulant therapy) and control group (routine treatment ), with 28 patients in each group. The results of prehospital and post-hospital resuscitation were evaluated. the levels of plasminogen activator (t-PA), plasminogen activator inhibitor-1 (PAI- 1), and record the occurrence of cardiovascular events and adverse reactions were compared. Results: The effective rate of pre-hospital rescue was 96.43% in the observation group and 92.86% in the control group, the difference was not statistically significant (x2=0.35, p=0.55); the effective rate of the observation group was 92.86%, and the effective rate was 92.86% in the control group. The difference was not statistically significant (x2=0, p=1.00). The level of t-PA expression in observation group was higher than that in control group (t=3.53, p=0.00095), and the level of PAI-1 was lower than that of control group (t=2.51, p=0.016). The incidence of gastrointestinal discomfort (x2=0.09, p=0.76), ecchymosis (x2=0.12, p=0.73) and gastrointestinal bleeding (x2=0.18, p=0.67) were not statistically different between the two groups. The incidence of cardiovascular events in the observation group was 12.00%, which was significantly lower than that in the control group (41.67%). The difference was statistically significant (x2=5.53, p=0.019). Conclusion: Pre-hospital anti-platelet therapy can reduce the incidence of cardiovascular events in patients with ST-segment elevation myocardial infarction and improve the patients'fibrinolysis imbalance without increasing the side effects. It is worthy of clinical application

Key words： Prehospital Anticoagulation ST-segment elevation myocardial infarction Fibrinolytic system Prognosis

基金资助:彝族地区县(市)级综合医院应急救治突发公共卫生事件模式研究,(编号:15YYJS035)

引用本文:

范从华. 院前抗凝治疗对ST段抬高心肌梗死患者预后影响分析[J]. 河北医学, 2017, 23(4): 616-619.
FAN Conghua. Analysis of the Effect of Pre-hospital Anticoagulant Therapy on the Prognosis of Patients with Myocardial Infarction with ST Segment Elevation. 河北医学, 2017, 23(4): 616-619.

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http://www.hbyxzzs.cn/CN/10.3969/j.issn.1006-6233.2017.04.025 或 http://www.hbyxzzs.cn/CN/Y2017/V23/I4/616

[1] 吴锡桂.我国人群冠心病流行现况与趋势[J].中国慢性病预防与控制,2003,11(4):190~191.
[2] 刘小清.冠心病流行病学研究进展及疾病负担[J].中华心血管病杂志,2008,36(6):573~576.
[3] lgen JS, Manini AF, Hoffmann U, et al. Prognostic utility of the acute cardiac ischemia time-insensitive predictive instrument (ACI-TIPI)[J].Int Emerg Med. 2011 Jul 31;4(1):49.
[4] 张海澄,郭继鸿.冠心病流行病学与一级预防[J].中国实用内科杂志,2002,22(8):449~451.
[5] De WS, Eitel I, Desch S, et al. Impact of multivessel coronary artery disease on reperfusion success in patients with ST-elevation myocardial infarction:A substudy of the AIDA STEMI trial[J].2015.
[6] 中华医学会心血管病学分会《中华心血管病杂志》编辑委员会.不稳定性心绞痛和非ST段抬高心肌梗死诊断与治疗指南[J].中华心血管病杂志,2007,3(35):1~14.
[7] 沈崇灵;法理学.标题为空[J].期刊名称缺失,1994(期缺失):51~52.
[8] Nguyen B, Fennessy M, Leya F, et al. Comparison of primary percutaneous coronary intervention in patients with ST-elevation myocardial infarction during and prior to availability of an in-house STEMI system:early experience and intermediate outcomes of the HARRT program for achieving routine D2B times60 minutes[J].Catheter Cardiovasc Interv, 2015, 86(2): 186~196.
[9] Orsi PR, Seito LN, Di Stasi LC. Hymenaea stigonocarpa Mart^[J]. ex Hayne:A tropical medicinal plant with intestinal anti-inflammatory activity in TNBS model of intestinal inflammation in rats[J].Ethnopharmacol, 2014, 151(1): 380~385.
[10] 廖树盛.院前急救72例急性心肌梗死患者临床分析[J].右江医学,2009,37(4):473~474.
[11] 许海燕,姚康宝.顼志敏等.首次急性ST段抬高与非ST段抬高心肌梗死患者临床及冠状动脉病变特点比较[J].中华老年心脑血管病杂志,2012,14(4):361~363.
[12] 蒋逸风,程心培.急性心肌梗死转院前的处理[J].海军医学杂志,2009,30(3):208~210.
[13] 国家卫生计生委合理用药专家委员会.中国药师协会.急性ST段抬高型心肌梗死溶栓治疗的合理用药指南[J].中国医学前沿杂志:电子版,2016,8(8):25~41.
[14] 任利辉,叶慧明,曹世长,等.急性ST段抬高型心肌梗死与非ST段抬高型急性冠脉综合征患者PCI后的长期死亡率比较[J].中国老年学杂志,2013,33(19):4673~4675.
[15] 刘群,赵冬,刘军,等.中国ST段抬高急性冠状动脉综合征诊疗现况调查[J].中华心血管病杂志,2009,37(3):213~217.
[16] Chandrasekhar J, Mehran R. The ideal anticoagulation strategy in ST-Elevation myocardial infarction[J].Prog Cardiovasc Dis, 2015, 58(3): 247~259.
[17] Bugiardini R, Dorobantu M, Vasiljevic Z, et al. Unfractionated heparin-clopidogrel combination in ST-elevation myocardial infarction not receiving reperfusion therapy[J].Atherosclerosis, 2015, 241(1): 151~156.