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目的：研究肝素治疗急性冠状动脉综合征（ＡＣＳ）时并发症的发生率及其影响因素，总结肝素停药后再发胸痛现象和防治方法，藉以评价肝素治疗的安全性。方法：５３３例急性冠状动脉综合征患者（ＡＭＩ３０５例，ＵＡ２９８例）急诊入院后，除常规治疗外，给予肝素钠连续静滴，部分患者给予尿激酶静脉溶栓后，继以肝素钠连续静滴，按照联合用药，２４小时内应用肝素钠剂量，肝素治疗期间监测凝血时间以及停药方式不同进行分组。分别观察中重度出血，轻度出血，过敏反应，血小板减少及停用肝素后心电图恶化，再发胸痛的发生频率，采用χ２检验。相对危险度按下列公式计算ＲＲ＝ａ／（ａ＋ｂ）／ｃ／（ｃ＋ｄ）。结果：阿斯匹林＋肝素治疗急性冠脉综合征的出血并发症发生率与阿斯匹林＋肝素＋尿激酶组比较无显著差异（Ｐ＞０．５０）；凝血时间＞１８ｍｉｎ组比＜１１ｍｉｎ组轻度出血并发症显著增加（Ｐ＜０．００５）。肝素用量在１８７５０Ｕ／２４ｈ～２５０００Ｕ／２４ｈ组比６２５０Ｕ／２４ｈ～１２５００Ｕ／２４ｈ出血并发症显著增加（Ｐ＜０．００５）；突然停药后再发胸痛及心电图恶化率均显著高于减量停药及加服阿斯匹林组（Ｐ＜０．００１）。结论：肝素用于治疗急性冠脉综合征不仅有效，而?
Objective: To study the incidence and influencing factors of heparin in the treatment of acute coronary syndrome (ACS), and to summarize the phenomenon of recurrent chest pain after heparin withdrawal and the prevention and treatment methods to evaluate the safety of heparin therapy. Methods: 533 patients with acute coronary syndrome (AMI305 cases, UA298 cases) were admitted to the hospital after emergency admission, except for routine treatment, heparin sodium continuous intravenous infusion, some patients given urokinase intravenous thrombolysis, followed by heparin sodium continuous intravenous infusion , According to the combination of medication, the application of heparin within 24 hours of the dose of heparin during the monitoring of coagulation time and discontinuation of different ways to be grouped. The incidences of recurrence of chest pain were observed using χ2 test, respectively, in moderate to severe bleeding, mild bleeding, anaphylaxis, thrombocytopenia and deterioration of electrocardiogram after heparin was stopped. The relative risk is calculated as follows: RR = a / (a + b) / c / (c + d). Results: The incidence of bleeding complication of aspirin + heparin in patients with acute coronary syndrome was no significant difference (P> 0.50) compared with aspirin + heparin + urokinase group; the clotting time> 11min mild bleeding complications increased significantly (P <0.005). Heparin dosage in 18750U / 24h ~ 25000U / 24h group than 6250U / 24h ~ 12500U / 24h bleeding complications increased significantly (P <0.005); sudden withdrawal after chest pain and ECG deterioration rate were significantly lower than the reduction of stop Medicine plus aspirin plus (P <0.001). Conclusion: Heparin is not only effective for the treatment of acute coronary syndromes,