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目的:观察在冠脉造影和PCI术中鞘内注射低分子肝素(LMWH)抗凝的有效性和安全性。方法:将我院2006~2009年290例单独行冠脉造影或造影同时需行PCI术的患者分为两组,实验组140例,对照组150例。实验组在冠脉造影和PCI术中应用LMWH,对照组应用常规剂量的普通肝素。观察入选后30 d内的主要终点事件(心源性死亡、心肌梗死、急诊血运重建、中风)及次要终点(血肿、假性动脉瘤、出血)事件发生情况。结果:在介入手术经鞘管弹丸式推注低分子肝素,入选后30 d内两组术后主要终点事件发生率,对照组为0.67%,实验组无终点事件发生,对照组高于实验组,但差异无统计学意义(P>0.05)。对照组动脉穿刺部位的假性动脉瘤6例(4.00%),皮下血肿13例(8.67%);实验组分别为2例(1.43%)和4例(2.86%),均低于对照组,差异有统计学意义(P<0.05)。结论:低分子肝素在冠脉造影和PCI术中应用安全,且明显减少周围血管并发症的发生。
Objective: To observe the effectiveness and safety of intrathecal LMWH anticoagulation during coronary angiography and PCI. Methods: 290 patients in our hospital from 2006 to 2009 who underwent coronary angiography or angiography simultaneously were divided into two groups: experimental group (140 cases) and control group (150 cases). The experimental group in the coronary angiography and PCI using LMWH, the control group of conventional doses of unfractionated heparin. The incidence of major endpoints (cardiac death, myocardial infarction, emergency revascularization, stroke) and secondary end points (hematoma, pseudoaneurysm, hemorrhage) within 30 days of enrollment were observed. Results: In the interventional procedure, the incidence of postoperative primary end point events in both groups was 0.67% within 30 days after enrollment with sheath-and-bolus injection of low-molecular-weight heparin. There was no end point event in the experimental group and the control group was higher than the experimental group , But the difference was not statistically significant (P> 0.05). 6 cases (4.00%) and 13 cases (8.67%) had false aneurysm at the arterial puncture site in the control group; 2 cases (1.43%) and 4 cases (2.86%) in the experimental group were lower than the control group, The difference was statistically significant (P <0.05). Conclusion: Low molecular weight heparin is safe in coronary angiography and PCI, and significantly reduces the occurrence of peripheral vascular complications.