国产注射用比伐卢定和肝素在冠状动脉介入治疗术中对血小板功能的影响

Effect of Domestic Bivalirudin and Heparin on Platelet Function During Percutaneous Coronary Intervention

目的:探讨国产注射用比伐卢定和肝素在经皮冠状动脉介入治疗(PCI)术中对血小板功能的影响。方法:选择36例择期行PCI的患者,术中用肝素(肝素组,n=18)或国产注射用比伐卢定(比伐卢定组,n=18)抗凝。分别在用药前、用药后10min、用药结束、用药结束后30min、用药结束后2h静脉采血,检测二磷酸腺苷诱导的血小板最大聚集率和血浆P选择素水平。结果:肝素组患者用药后血小板最大聚集率及血浆P选择素水平升高,用药后10min与用药前比较,差异均有统计学意义(P均<0.05),其余各时间点与用药前比较,差异均无统计学意义(P均>0.05)。比伐卢定组患者血小板最大聚集率及血浆P选择素水平,用药后10min及用药结束与用药前比较均降低(P均<0.05),差异均有统计学意义;用药结束后30min与用药前比较,差异无统计学意义(P>0.05)。结论:与常规肝素抗凝相比,国产注射用比伐卢定作为抗凝剂应用于PCI术中可以短时间内降低血小板活性、抑制血小板聚集,具有暂时性抗血小板的功能。

Objective： To investigate the effect of domestic bivalirudin and heparin on platelet function during percutaneous coronary in- tervention （PCI）. Methods ：Thirty six selected PCI patients were randomized into two groups, Heparin group （n = 18 ） and Bivalirudin group （n = 18 ）, intravenous domestic bivalirudin and heparin were respectively injected as anticoagulants for PCI procedure. Platelet maximum aggregation （PMA） rate induced by adenosine diphosphate and P-selection were measured 10 minutes after the first injection, before PCI procedure, at the end of PC/, and 30 minutes, 2 hours after PCI procedure respectively. Results： In Heparin group, PMA and the level of P-selection were significantly increased at 10 minutes after the injection （P 〈 0.05 respectively） and then gradually fell back to normal. In Bivalirudin group, PMA and P-selection were significantly decreased 10 minutes after the injection and then maintained the lower level until the end of PCI procedure （ P 〈 0.05 respectively）. While for 30 minutes after the injection, both PMA and P-selection returned near the basal level （P 〉 0.05 ）. Conclusion： Compared with the conventional anticoagulant heparin, bivalirudin could decrease platelet activity and inhibit olatelet aggregation at the short period of time during PCI.