目的 探討磺達(dá)肝癸鈉聯(lián)合尼可地爾治療急性ST段抬高型心肌梗死(STEMI)的臨床療效。方法 選取2012年1月—2014年12月天津市海河醫(yī)院收治的STEMI患者80例,隨機(jī)分為對(duì)照組和治療組,每組各40例。兩組均行經(jīng)皮穿刺冠脈成形術(shù)(PCI),術(shù)后常規(guī)給予抗凝藥物。對(duì)照組在確診后即刻口服尼可地爾片20 mg/次,之后5 mg/次,3次/d。治療組在對(duì)照組基礎(chǔ)上PCI術(shù)后皮下注射磺達(dá)肝癸鈉注射液2.5 mg/次,1次/d。兩組均連續(xù)治療5 d,隨訪30 d。觀察兩組的臨床療效,同時(shí)比較兩組血流TIMI分級(jí)和N-末端腦鈉肽前體(NT-proBNP)的變化。結(jié)果 治療后,兩組總有效率分別為92.50%、95.00%,兩組比較差異無統(tǒng)計(jì)學(xué)意義。治療后,兩組血流TIMI分級(jí)情況均顯著改善,同組1～2級(jí)病例數(shù)及比例較治療前顯著減少,3級(jí)病例數(shù)及比例顯著增加,同組治療前后差異有統(tǒng)計(jì)學(xué)意義(P <0.05);且治療組的改善情況優(yōu)于對(duì)照組,兩組比較差異有統(tǒng)計(jì)學(xué)意義(P <0.05)。治療后兩組lg_(NT-proBN/P)均顯著降低,同組治療前后比較差異有統(tǒng)計(jì)學(xué)意義(P <0.05);且治療組的降低程度優(yōu)于對(duì)照組,兩組比較差異有統(tǒng)計(jì)學(xué)意義(P <0.05)。治療組出血并發(fā)癥和血小板減少癥發(fā)生率均顯著低于對(duì)照組,兩組比較差異有統(tǒng)計(jì)學(xué)意義(P <0.05)。結(jié)論 磺達(dá)肝癸鈉聯(lián)合尼可地爾應(yīng)用于STEMI患者PCI治療圍術(shù)期具有較好的臨床療效,可顯著降低出血和血小板減少癥的發(fā)生率,同時(shí)有助于改善患者心功能,具有一定的臨床推廣應(yīng)用價(jià)值。

Objective To investigate the curative effect of fondaparinux sodium combined with nicorandil in treatment of acute ST-segment elevation myocardial infarction. Methods Patients (80 cases) with acute ST-segment elevation myocardial infarction in Tianjin Haihe Hospital from January 2012 to December 2014 were randomly divided into control and treatment groups. Each group had 40 cases. Patients in two groups were performed PCI surgery, and routine anticoagulation drugs were used postoperative. Patients in control group were po administered with Nicorandil Tablets 20 mg/time immediately after diagnosis, and then 5 mg/time, three times daily. Patients in control group were sc administered with Fondaparinux Sodium Injection after PCI on the basis of the control group, 2.5 mg/time, once daily. Two groups were treated for 5 d, and 30 d was followed up. After treatment, the efficacy was evaluated, and the changes of flow TIMI grade and N-terminal brain natriuretic peptide precursor (NT-proBNP) in two groups were compared. Results After treatment, the efficacies in the control and treatment groups were 92.50% and 95.00%, respectively, and there was no difference between two groups. After treatment, flow TIMI grade in two groups improved significantly, the number and ratio of level 1 — 2 was significantly reduced, while the number and ratio of level 3 was significantly increased, and the difference was statistically significant in the same group (P < 0.05). And the improvement of the treatment group was better than that in the control group, with significant differences between two groups (P < 0.05). After treatment, lg_(NT-proBN/P) in two groups were significantly reduced, and the difference was statistically significant in the same group (P < 0.05). Lower level in the treatment group was better than that of control group, with significant differences between two groups (P < 0.05). The incidences of bleeding complications and thrombocytopenia in the treatment group were significantly lower than those in the control group, with significantdifferences between two groups (P < 0.05). Conclusion Fondaparinux sodium combined with nicorandil has good clinical curative effect in treatment of acute ST-segment elevation myocardial infarction, and can significantly reduce the incidence of bleeding and thrombocytopenia, and can improve cardiac function, which has a certain clinical application value.