比伐卢定在高血栓负荷急性ST段抬高型心肌梗死介入治疗中的应用

Clinical application of domestic bivalirudin during percutaneous coronary intervention to acute ST-segment elevation myocardial infarction patients with large thrombus burden

目的观察国产注射用比伐卢定用于高血栓负荷的急性ST段抬高型心肌梗死(STEMI)急诊经皮冠状动脉介入治疗(PCI)中的有效性及安全性。方法选择血栓负荷重的47例行急诊PCI术的急性STEMI患者随机分为比伐卢定组(冠脉及静脉内注射国产比伐卢定,n=24)和血栓抽吸组(行血栓抽吸,n=23)。比较两组在PCI术后心肌再灌注指标、左室射血分数(LVEF)及主要心血管不良事件(MACE)方面的差异。结果两组基线情况差异无统计学意义;术后2 h胸痛缓解、TIMI血流Ⅲ级、术后90 min ST段回落大于50%、CKMB峰值时间及CKMB峰值、术后1月LVEF方面差异无统计学意义;在主要心血管不良事件(包括3月内死亡、支架内血栓形成、梗死后心绞痛及严重出血)方面差异无统计学意义。结论高血栓负荷的急性STEMI急诊PCI术中应用国产比伐卢定安全有效。

Objective To observe the efficacy and safety of domestic bivalirudin during emergency percutaneous coronary intervention （PCI）in patients with acute ST- segment elevation myocardial infarction （STEMI） with large thrombus burden. Methods 47 patients of acute STEMI underwent PCI were randomly divided into bivalirudin group （ intracoronary and intravenous domestic bivalirudin injection, n = 24） and thrombus aspiration group （ thrombus aspiration, n = 23 ）. The data of myocardial reperfusion, left ventricular ejection fraction （LVEF） and major adverse cardiac events（MACE） of both groups were compared. Results There was no significant difference in the basic situation （ P 〉 0.05 ） between the two groups. And there was no significant difference between the two groups in relief of pain, the ratio of final TIMI grade three flow,50% resolution ratio of ST - segment elevation 90 minutes after PCI, peak - value and peak - time of CK - MB, LVEF after 1 month （ P 〉 0.05 ）. Both groups had no significant difference in MACE （ mortality, intra - stent thrombosis, post - infarction angina pectoris, major bleeding）. Conclusion Application of domestic bivalirudin to patients during PCI with acute STEMI with large thrombus burden is effective and safe.