比伐卢定对IABP辅助下AMI行PCI患者治疗后的疗效及对血小板数量和MACE的影响

Efficacy of bivalirudin in the treatment of AMI patients received PCI under the assistance of IABP and its effect on platelet count and MACE

目的探讨比伐卢定主动脉内球囊反搏术(IABP)辅助下急性心肌梗死(AMI)患者行经皮冠状动脉介入(PCI)治疗的疗效以及安全性。方法回顾分析北京安贞医院自2014年5月至2016年5月收治的88例接受IABP联合PCI治疗的AMI患者的临床资料,根据术中抗凝药使用的不同分为对照组和观察组两组。其中对照组患者46例,药物为肝素;观察组患者42例,药物为比伐卢定,比较两组患者的治疗效果、对血小板的影响以及心脏不良事件(MACE)的发生率。结果两组患者PCI前、注射药物后5min、术后即刻的ACT差异不大,但停药后30 min、1 h、2 h观察组患者的ACT均显著低于对照组(P<0.05);两组患者手术前、手术后的血小板数差异不大,但观察组患者手术后的血小板数下降程度显著小于对照组;观察组患者术后MACE事件的总发生率为9.52%,显著低于对照组的26.09%(P<0.05)。结论比伐卢定对于经IABP辅助下的AMI患者进行PCI治疗的疗效更好,对血小板影响小,安全性高,可在临床上广泛使用。

Objective To investigate the efficacy and safety of bivalirudin in the treatment of AMI （acute myocardial infarction ） patients who received PCI （pereutaneous coronary intervention ） under the assistance of IABP （ acute myocardial infarction） .Methods The clinical data of 88 patients with AMI treated by IABP combined with PCI in An Zhen Hospital of Beijing city from May 2014 to May were analyzed retrospectively, according to the different use of anticoagulant drugs they were divided into the control group and the observation group. In the control group, 46 cases were controlled with heparin. There were 42 cases in observation group, the drug was bivalirudin. The effects of the two groups of patients and the influence on platelet were compared, as well as the incidence of MACE （cardiac adverse events ）. Results The difference of ACT between the two groups of patients at the time points before PCI, 5min after the injection of drugs and the immediate postoperative was not statistically significant. But 30min, lh and 2h after stopping the drug, ACT in the observation group was significantly lower than the control group （P〈 0. 05 ）. No matter before or after the treatment the difference of platelet count of the two groups was not significant, but the decrease degree of platelet count in the observation group was significantly lower than that of the control group, the total incidence rate of MACE after operation in the observation group was 9.52%, which was significantly lower than that of the control group （P〈0.05）. Conclusions The efficacy of bivalirudin in the treatment of AMI patients with PCI under the assistance of IABP was better, the impact on platelet was small, it has high safety, can be widely used in clinical.