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1、低分子肝索改善慢性心力衰竭患者心功能的临床研究作者：张子学，郝学军,贺晓华单位：河北省抚宁县人民医院内三科【摘要】目的观察低分子肝素(法安明)対慢性心力衰竭(心衰)患者凝血功能及心功能的影响。方法98例慢性心衰患者(NYHA分级II〜IU级)随机分成2组，治疗组(49例)和対照纽.(49例)。对照组给予强心、利尿、扩血管治疗，治疗组在此基础上加用低分子肝索5000U/次皮卜注射,2次/d共1个月。治疗后检查心脏超声，评估心功能，测定血浆D二聚体，血浆纤维蛋白原水平。结杲1个月后治疗组血浆D二聚体，血浆纤维蛋白原水平明显降低(P&1匕0.01)。心功能按NYHA分级治疗
2、组与对照纠.比较有明显改善(P<0.01),左室射血分数有明显提高(P<0.01)o结论低分子肝素能降低血浆D二聚体，血浆纤维蛋白原水平，改善心脏功能，有益于慢性心衰的治疗。【关键词】肝素，低分子量；心力衰竭，充血性；心功能；凝血功能ClinicalstudyontheprotectiveeffectsoflowmolecularweightheparinoncardiacfunctionofpatientswithchronicheartfailureZHANGZixue,HAOXuejun,HEXiaohua・DepartmentofInternalM
3、edicine,FuningCountryPeople'sHospital,Hebei,Funing066300[Abstract]ObjectiveToobservetheeffectsoflowmolecularweightheparinoncardiacfunctionandcoagulationfunctionofpatientswithchronicheartfailure.Methods98patientswithchronicheartfailure(NYHAGradeII~I「)wererandomlydividedintotwogroups・49p
4、atientsincontrolgroupweretreatedbycardiac,diureticanddilatingvessels,whiletheother49patientsintreatmentgroup,onthetherapeuticbasisofcontrolgroup,weretreatedwithlowmolecularweightheparin5000Uonce,twiceadayfor1month.Onemonthaftertreatment,thelevelsofplasmafibrinDdimerandfibrinogenweretest
5、edandcardiacfunctionweredetectedbyechocardiogram.ResultsOnemonthaftertreatment,thelevelsofplasmafibrinDdimerandfibrinogenwereobviouslydecreasedintreatmentgroup,ascomparedwiththoseofcontrolgroup(P<0.01).Atthesametime,thecardiacfunction(NYHAGradeII〜IV)intreatmentgroupwassignificantlyim
6、proved,ascomparedwiththatofcontrolgroup(P<0.01),andleftventricularejectionfractionintreatmentgroupwasobviouslyincreased(P<0・01)・ConclusionThelowmolecularweightheparincanimprovecardiacfunction,reducelevelsofplasmafibrinDdimerandfibrinogen,whichishelpfultotreatchronicheartfailure.[K
7、eywords]lowmolecularweightheparin;chronicheartfailure;cardiacfunction;coagulationfunction心力衰竭(心衰)是任何原因的初始心肌损伤(心肌極死、血流动力负荷过重、炎症)，引起心肌结构和功能的变化，最后导致心室射血和充盈功能低下[1]。在初始心肌损伤后有多种内源性神经激索(如交感活性、肾素血管紧张索(RAA)系统精氨酸加压索等)和细胞因子(如肿瘤坏死因子α＞白濮6)被激活，神经激素和细胞因子等长期的慢性激活促使心肌車塑,加亜心肌损伤和心功能损害，后者又进-
