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

Comparison of the efficacy and safety between Bivalirudin and Heparin during emergency percutaneous coronary intervention in elderly patients with acute ST-segment elevation myocardial infarction

目的观察老年急性ST段抬高心肌梗死患者行急诊介入治疗中应用比伐卢定的疗效和安全性。方法回顾性分析2011年3月至2015年3月确诊为ST段抬高心肌梗死的老年患者，其中治疗组40例急诊介入治疗术前给予1次性静脉注射比伐卢定负荷剂量0．75mg／kg，随后术中1．75mg·kg^-1·h^-1维持静脉滴注至手术结束，静脉注射10min后检测活化凝血时间（ACT），如果ACT〈225S，则追加0．3mg／kg；对照组40例在急诊介入治疗术中1次性注射普通肝素100U／kg，注射10min后测ACT，如果ACT〈225S，则追加肝素300U，手术每延长1h，补充1000U肝素。比较两组患者术后即刻血流、早期支架内血栓形成情况，术后30d靶血管重建、再发心肌梗死、非致死性脑血管意外、全因死亡；两组患者术后7d出血情况。结果治疗组术后即刻TIMI血流改善，与对照组比较差异有统计学意义（P〈0．05）；两组患者在术后30d靶血管重建、再发心肌梗死、非致死性脑血管意外、全因死亡比较差异无统计学意义（均P〉0．05）；对照组术后7d出血学术研究联合会（BARC）2型出血22．5％（9例），与治疗组2．5％（1例）比较，差异有统计学意义（χ^2=7．31，P〈0．01）。结论老年急性ST段抬高心肌梗死患者急诊介入治疗中应用比伐卢定较肝素未明显降低主要心血管不良事件，但可改善患者术后TIMI血流，降低出血发生率，提示在老年ST段抬高心肌梗死患者急诊介入治疗中应用比伐卢定更为安全。

Objective To compare the efficacy and safety between Bivalirudin and Heparin during emergency percutaneous coronary intervention（PCI）in elderly patients with acute ST-segment elevation myocardial infarction（STEMI）. Methods Retrospective analysis of 80 patients diagnosed with ST- segment elevation myocardial infarction in elderly patients was conducted. The treatment group（ n =40） received a bolus intravenous injection of Bivalirudin 0.75 mg/kg before emergency percutaneous coronary intervention,then 1.75 mg·kg^-1·h^-1 continuous intravenous drip till the end of the operation from March 2011 to March 2015. Activated clotting time（ACT）was detected at 10 minutes after drug application. If ACT〈225 s, 0.3 mg/kg were append. The control group received a bolus intravenous injection of Heparin 100 U/kg during emergency PCI, and after 10 minutes ACT was detected. If ACT〈225 s, 300 U was appended. When operation extended, 1 000 U was appended every 1 hour. Immediate postoperative blood flow, early stent thrombosis, target vessel reconstruction at 30 days after operation, recurrent myocardial infarction, non-fatal cerebrovascular accident, all causes mortality and bleeding conditions at 7 days after operation were compared between two groups. Results The immediate postoperative thrombolysis in myocardial infarction（TIMI）blood flow was significantly improved（P〈0.05）in the treatment group as compared with control group. There was no significant difference in target vessel reconstruction at 30 days after operation, recurrent myocardial infarction,non-fatal cerebrovascular accident, and all-cause mortality between two groups （all P〉0. 05）. The bleeding conditions at 7 days after operation were significant lower in the treatment group [2.5%（1 case）]than in the control group[22.5%（9 cases）] （χ^2 =7.31 ,P〈0.01）. Conclusions Bivalirudin treatment does not reduce the major cardiovascular events, but improves the TIMI blood flow after surgery and the incidence of bleeding as compared with control group, which suggests that Bivalirudin is safer in emergency PCI therapy in elderly patients with acute ST-segment elevation myocardial infarction