目的 探讨磺达肝癸钠联合尼可地尔治疗急性ST段抬高型心肌梗死(STEMI)的临床疗效。方法 选取2012年1月—2014年12月天津市海河医院收治的STEMI患者80例,随机分为对照组和治疗组,每组各40例。两组均行经皮穿刺冠脉成形术(PCI),术后常规给予抗凝药物。对照组在确诊后即刻口服尼可地尔片20 mg/次,之后5 mg/次,3次/d。治疗组在对照组基础上PCI术后皮下注射磺达肝癸钠注射液2.5 mg/次,1次/d。两组均连续治疗5 d,随访30 d。观察两组的临床疗效,同时比较两组血流TIMI分级和N-末端脑钠肽前体(NT-proBNP)的变化。结果 治疗后,两组总有效率分别为92.50%、95.00%,两组比较差异无统计学意义。治疗后,两组血流TIMI分级情况均显著改善,同组1～2级病例数及比例较治疗前显著减少,3级病例数及比例显著增加,同组治疗前后差异有统计学意义(P <0.05);且治疗组的改善情况优于对照组,两组比较差异有统计学意义(P <0.05)。治疗后两组lg_(NT-proBN/P)均显著降低,同组治疗前后比较差异有统计学意义(P <0.05);且治疗组的降低程度优于对照组,两组比较差异有统计学意义(P <0.05)。治疗组出血并发症和血小板减少症发生率均显著低于对照组,两组比较差异有统计学意义(P <0.05)。结论 磺达肝癸钠联合尼可地尔应用于STEMI患者PCI治疗围术期具有较好的临床疗效,可显著降低出血和血小板减少症的发生率,同时有助于改善患者心功能,具有一定的临床推广应用价值。

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.