比伐卢定在老年急性ST段抬高心肌梗死患者经皮冠状动脉介入治疗中的应用效果
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摘要
目的探讨比伐卢定在老年急性ST段抬高心肌梗死患者经皮冠状动脉介入治疗中的应用效果。方法将行急诊经皮冠状动脉介入治疗的老年急性ST段抬高心肌梗死患者94例随机分为观察组与对照组,每组47例。观察组术前给予比伐卢定静脉快速推注,术中持续静脉泵注至术毕,对照组术前给予肝素钠快速静脉滴注。比较两组患者术后凝血指标、纤维蛋白原、炎性因子水平,比较两组患者术后的心肌梗死溶栓治疗(TIMI)血流分级情况及术后30 d再出血发生率。结果两组患者术后的活化部分凝血酶时间、凝血酶时间、凝血酶原时间及纤维蛋白原差异均无统计学意义(均P> 0. 05);但观察组患者术后7 d超敏C反应蛋白水平及术后30 d再出血发生率低于对照组,术后TIMI血流分级优于对照组(均P <0. 05)。结论比伐卢定在老年急性ST段抬高心肌梗死患者行急诊经皮冠状动脉介入治疗中抗凝,抗凝效果与肝素钠相当,但其还可以降低患者术后炎性因子水平,减轻血管内炎性反应,降低术后出血风险。
Objective To explore the application efficacy of bivalirudin during percutaneous coronary intervention( PCI) in elderly patients with acute ST-segment elevation myocardial infarction( ASTEMI). Methods Ninety-four elderly ASTEMI patients undergoing emergent PCI were randomly allocated to observation group or control group,with47 cases in each group. The observation group received bivalirudin by rapid intravenous push before operation and continuous intravenous pumping during operation till the end of the operation,while the control group received heparin sodium by intravenous drip infusion before operation. The postoperative coagulation parameters,fibrinogen and inflammatory factors levels,as well as blood flow grade of thrombolysis in myocardial infarction( TIMI) and incidence of re-bleeding during 30 days after surgery,were compared between the two groups. Results There were no significant differences in postoperative activated partial thromboplastin time,thrombin time,prothrombin time,or fibrinogen between the two groups( all P > 0. 05); but the observation group was found with lower level of hypersensitive C-reactive protein at postoperative 7 days and incidence of re-bleeding during 30 days after surgery,and superior blood flow grade of TIMI compared to the control group( all P < 0. 05). Conclusion For ASTEMI patients,bivalirudin can obtain a similar anticoagulant effect to heparin sodium during emergent PCI,but it can additionally palliate the postoperative inflammatory factors levels,alleviate the intravascular inflammatory response,and reduce the risk of postoperative bleeding.
Objective To explore the application efficacy of bivalirudin during percutaneous coronary intervention( PCI) in elderly patients with acute ST-segment elevation myocardial infarction( ASTEMI). Methods Ninety-four elderly ASTEMI patients undergoing emergent PCI were randomly allocated to observation group or control group,with47 cases in each group. The observation group received bivalirudin by rapid intravenous push before operation and continuous intravenous pumping during operation till the end of the operation,while the control group received heparin sodium by intravenous drip infusion before operation. The postoperative coagulation parameters,fibrinogen and inflammatory factors levels,as well as blood flow grade of thrombolysis in myocardial infarction( TIMI) and incidence of re-bleeding during 30 days after surgery,were compared between the two groups. Results There were no significant differences in postoperative activated partial thromboplastin time,thrombin time,prothrombin time,or fibrinogen between the two groups( all P > 0. 05); but the observation group was found with lower level of hypersensitive C-reactive protein at postoperative 7 days and incidence of re-bleeding during 30 days after surgery,and superior blood flow grade of TIMI compared to the control group( all P < 0. 05). Conclusion For ASTEMI patients,bivalirudin can obtain a similar anticoagulant effect to heparin sodium during emergent PCI,but it can additionally palliate the postoperative inflammatory factors levels,alleviate the intravascular inflammatory response,and reduce the risk of postoperative bleeding.
引文
[1]李峰,张育民,全勇,等.比伐卢定在急性ST段抬高心肌梗死急诊经皮冠脉介入治疗患者中的疗效及安全性观察[J].中国现代医学杂志,2014,24(16):78-81.
[2]孙晋亮.比伐卢定联合不同抗血小板药物用于急性ST段抬高型心肌梗死PCI的疗效和安全性[J].中国循证心血管医学杂志,2016,8(5):550-552.
[3]刘菁晶,林文华.比伐卢定对急性ST段抬高型心肌梗死患者经皮冠状动脉介入术后炎性因子水平的影响[J].中国医药,2017,12(7):982-985.
[4]中华医学会心血管病学分会,中华心血管病杂志编辑委员会.急性ST段抬高型心肌梗死诊断和治疗指南[J].中华心血管病杂志,2015,43(5):380-393.
[5]洪涛.冠状动脉TIMI血流分级[J].中国介入心脏病学杂志,2003,11(3):154.
[6]张冬梅,杜蕊.经皮冠状动脉介入治疗术中比伐卢定对急性ST段抬高性心肌梗死患者凝血功能的影响分析[J].中西医结合心血管病电子杂志,2015,3(32):65-66.
[7]何鹏义,木胡牙提·乌拉斯汉,赵燕,等.比伐卢定或肝素联合替罗非班在ST段抬高心肌梗死患者直接经皮冠状动脉介入治疗围术期对血栓、出血及P-选择素的影响[J].中国介入心脏病学杂志,2017,25(6):313-320.
[8]李强,陈万国,温河.替格瑞洛联合比伐卢定在ST段抬高型心肌梗死患者直接PCI治疗中的应用[J].岭南心血管病杂志,2017,23(1):23-26.
[9]顾晓龙,林霖,龚志华,等.比伐卢定在急性ST段抬高型心肌梗死患者溶栓后介入治疗中的疗效与安全性研究[J].中国急救医学,2016,36(7):595-599.
[10]张鹏,解强,程颖,等.急性ST段抬高型心肌梗死患者急诊PCI术中应用比伐卢定的作用及效果[J].深圳中西医结合杂志,2017,27(6):103-104.
[11]杨晓雪,韩宇扬,张利,等.比伐卢定治疗出血高危急性ST段抬高型心肌梗死患者的疗效及安全性分析[J].临床合理用药杂志,2016,9(7):34-35.
[12]高海旺,卫海松,牛振山,等.比伐卢定在老年急性ST段抬高心肌梗死患者急诊介入治疗中的应用[J].中华老年医学杂志,2017,36(6):639-642.
[13]徐会圃,刘长梅.比伐卢定与替罗非班加肝素在急诊经皮冠状动脉介入治疗中疗效与安全性的比较[J].中国循环杂志,2013,28(6):430-433.
[14]杨晓雪,韩宇扬,张利,等.比伐卢定急诊PCI治疗急性ST段抬高型心肌梗死对患者心肌梗死面积及炎性反应的影响[J].临床合理用药杂志,2016,9(1):93-94,96.
[15]李颖佳,李学信,王斌.国产比伐卢定在老年急性心肌梗死患者急诊冠状动脉介入治疗的疗效及安全性观察[J].中国药物与临床,2016,16(2):231-233.
[2]孙晋亮.比伐卢定联合不同抗血小板药物用于急性ST段抬高型心肌梗死PCI的疗效和安全性[J].中国循证心血管医学杂志,2016,8(5):550-552.
[3]刘菁晶,林文华.比伐卢定对急性ST段抬高型心肌梗死患者经皮冠状动脉介入术后炎性因子水平的影响[J].中国医药,2017,12(7):982-985.
[4]中华医学会心血管病学分会,中华心血管病杂志编辑委员会.急性ST段抬高型心肌梗死诊断和治疗指南[J].中华心血管病杂志,2015,43(5):380-393.
[5]洪涛.冠状动脉TIMI血流分级[J].中国介入心脏病学杂志,2003,11(3):154.
[6]张冬梅,杜蕊.经皮冠状动脉介入治疗术中比伐卢定对急性ST段抬高性心肌梗死患者凝血功能的影响分析[J].中西医结合心血管病电子杂志,2015,3(32):65-66.
[7]何鹏义,木胡牙提·乌拉斯汉,赵燕,等.比伐卢定或肝素联合替罗非班在ST段抬高心肌梗死患者直接经皮冠状动脉介入治疗围术期对血栓、出血及P-选择素的影响[J].中国介入心脏病学杂志,2017,25(6):313-320.
[8]李强,陈万国,温河.替格瑞洛联合比伐卢定在ST段抬高型心肌梗死患者直接PCI治疗中的应用[J].岭南心血管病杂志,2017,23(1):23-26.
[9]顾晓龙,林霖,龚志华,等.比伐卢定在急性ST段抬高型心肌梗死患者溶栓后介入治疗中的疗效与安全性研究[J].中国急救医学,2016,36(7):595-599.
[10]张鹏,解强,程颖,等.急性ST段抬高型心肌梗死患者急诊PCI术中应用比伐卢定的作用及效果[J].深圳中西医结合杂志,2017,27(6):103-104.
[11]杨晓雪,韩宇扬,张利,等.比伐卢定治疗出血高危急性ST段抬高型心肌梗死患者的疗效及安全性分析[J].临床合理用药杂志,2016,9(7):34-35.
[12]高海旺,卫海松,牛振山,等.比伐卢定在老年急性ST段抬高心肌梗死患者急诊介入治疗中的应用[J].中华老年医学杂志,2017,36(6):639-642.
[13]徐会圃,刘长梅.比伐卢定与替罗非班加肝素在急诊经皮冠状动脉介入治疗中疗效与安全性的比较[J].中国循环杂志,2013,28(6):430-433.
[14]杨晓雪,韩宇扬,张利,等.比伐卢定急诊PCI治疗急性ST段抬高型心肌梗死对患者心肌梗死面积及炎性反应的影响[J].临床合理用药杂志,2016,9(1):93-94,96.
[15]李颖佳,李学信,王斌.国产比伐卢定在老年急性心肌梗死患者急诊冠状动脉介入治疗的疗效及安全性观察[J].中国药物与临床,2016,16(2):231-233.
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