经皮冠脉介入治疗术中应用比伐卢定的全血激活凝固时间监测及护理

Monitoring of activated clotting time during bivalirudin application in percutaneous coronary intervention

目的了解全血激活凝同时间（ACT）监测下比伐卢定对比肝素钠的抗凝效果和半衰期长短，以及相关操作中的护理流程。方法52例行经皮冠脉介入治疗（PCI）的患者随机均分为2组：比伐卢定实验组[PCI术前静脉注射0．75mg／kg，然后立即静脉滴注1．75mg／（kg·h）至术毕]和对照组（术前静脉注射肝素钠130U／kg）。分别于PCI术前，用药后5min，停药后30min、1h、和2h，以及拔管前5min（距离用药约5～6h）监测并记录6次ACT值。结果用药后5min患者实验组ACT显著长于对照组（P〈0．01）；PCI术前和停药后30min，2组患者ACT没有显著性差异（均P〉0．051；停药后1h、2h和拔管前5min实验组ACT显著短于对照组（均P〈0．05）。结论比伐卢定对比肝素钠抗凝效果起效快，效果好，半衰期短；严格按照规范用药、加强用药期间的观察护理，做好ACT监测及护理，可保证药物使用的有效性和安全性。

Objective To investigate the significance of monitoring activated clotting time （ACT） during bivalirudin application in percutaneous coronary intervention （PCI） among patients with coronary heart diseases. Methods Fifty-two patients with coronary heart diseases who were to undergo PCI were randomly divided into 2 equal groups： bivalirudin group undergoing intravenous injection of bivalirudin 0.75 mg/kg before PCI and then intravenous drip of bivalirudin 1.75 mg/（kg, h） immediately until the end of PCI, and control group undergoing intravenous injection of heparin sodium 130 U/kg before PCI. ACT was monitored before PCI, 5 min after drug administration, 30 min, 1h, and 2 h after drug withdrawal, and 5 min before extubation （5-6 h after drug administration）. Results There was not significant difference in the ACT value before PCI between these 2 groups. The ACT 5 min ＂after the drug administration of the bivalirudin group was significantly longer than that of the control group （P〈 0.01）. The ACT value 30 min after the drug withdrawal of the bivalirudin group was not significantly different from that of the control group （P〉0.05）. And the ACT values lh and 2h after drug withdrawal and 5 min before extubation of the bivalirudin group were all significantly shorter than those of the control group （all P〈0.05）. Conclusion Compared with heparin, bivalirudine takes effect more quickly, is more efficient against coagulation, and is with a shorter half life. ACT monitoring and careful nursing help raise the safety and effect of bivalirudine administration.