急性心肌梗死溶栓疗法对血浆凝血活性影响.docVIP

急性心肌梗死溶栓疗法对血浆凝血活性影响【摘要】 目的 探讨溶栓疗法对血浆凝血活性的影响。方法 连续监测35例急性心肌梗死患者，于确诊后定期从外周静脉采血，酶联免疫双抗体夹心法测定血浆凝血酶修饰抗凝血酶Ⅲ(antithrombin Ⅲ modified,ATM)和D-二聚体(D-D)的动态变化。结果 溶栓开始2 h后，血浆ATM显著性增加(87.80±25.19）μg/L，比（24．48±11．62）μg/L，（P0．05)，4 h达峰值(120．87±31．54）μg/L,持续3 d以上；血浆D-D于2 h即达到峰值(7．76±2．58）mg/L，比（2．7±1．36）mg/L，（P0．05)，维护 8 h以上，24 h以后恢复正常。在溶栓组患者，不同采血时刻血浆ATM和D-D的平均值呈明显正相关。未溶栓组患者血浆ATM和D-D浓度未见显著性变化。结论 溶栓疗法激活凝血系统，与血栓溶解的标志物(D-D)呈明显正相关。早期应用有效抗血栓药物可能抑制凝血系统的激活，减少血栓再闭塞的发生。 【关键词】心肌梗死；血栓溶解疗法；抗凝血酶Ⅲ；D-二聚体 The Influence of thromboly fhe therapy on plasma coagulation activation in acute myocardil infarctionHOU Cheng-gong.The Third People’s Hospital of Zhumadian，Zhumadian 463000,China 【Abstract】 Objective To investigate the influence of thrombolytic therapy on plasma thrombogenicity．Methods 35 patients with acute myocardial infarction were tested when the diagnosis of acute myocardial infarction was established，blood sampling was performed periodically，and plasma ATM(antithrombin Ⅲ modified)and D-D were determined by ELISA.Results Plasma ATM levels increased significantly(87．80±25．19)μg/L vs (24．28±11．62)μg/L，(P0．05).2 hours after thrombolytics administration，peaked 4 hours later at (120．87±31．54)μg/L，sustained for at least 3 days；Plasma D-D peaked in 2 hours(7．76±2．58)mg/L，vs(2．74±1．36)mg/L，(P0．05)and retumed progressively to normal 24 hours after thrombolysis.A Positive correlateion was present between plasma ATM and D-D levels in thrombolytic patients without-thrombolysis,no significant changes were found in Plesme ATM anb D-D levels bur ing the whole monitoring period.Conclusion Thrombolytic therapy activites coagulation system which is elevative positively related to clotlysis(plasma D-D).Earlier administration of intensive anticoagulation may benefit from thrombolytic therapy for patients with acute myocardial infarction. 【Key words】 Myocarbial infarction;Thrombolytic therapy;Antithrombin Ⅲ modifted；D-Dimer 溶栓疗法是一项成熟的治疗技术，临床开通率75%~80%，能降低病死率30%左右。但溶栓疗法只能使50%的梗塞相关动脉到达完全(TIMIⅢ)、持续的冠