比伐卢定在高龄急性ST段抬高型心肌梗死患者急诊PCI治疗中的效果观察

Efficacy and safety of bivalirudin in elderly patients with acute ST-elevation myocardial infarction undergoing emergency percutaneous coronary intervention

【目的】探讨比伐卢定在急诊经皮冠状动脉介入治疗(percutaneous coronary intervention,PCI)高龄急性ST段抬高型心肌梗死(ST-segment elevated myocardial infarction,STEMI)患者中的有效性及安全性。【方法】序贯入选在我院住院并行急诊PCI治疗的>75岁的STEMI患者80例,随机分为比伐卢定组和普通肝素组。比伐卢定组在PCI术前先静脉给予比伐卢定负荷量(0.75 mg/kg),然后以1.75 mg·(kg·h)^(-1)持续静脉点滴4 h;普通肝素组PCI术前给予普通肝素130 IU/kg抗凝治疗。比较两组患者给药后不同时间点的抗凝效果,并观察两组患者住院期间主要不良心血管事件(major adverse cardiovascular events,MACE)和出血事件的发生率。【结果】两组患者基线临床资料的比较差异无统计学意义(P>0.05);两组患者在用药后5 min激活凝固时间(activated clotting time,ACT)均已达到PCI手术抗凝标准(>225 s),停药后30 min、1 h、2 h比伐卢定组ACT均显著低于普通肝素组,差异有统计学意义(P<0.05);两组患者住院期间MACE事件发生率比较差异无统计学意义(P>0.05);比伐卢定组出血发生率更低,差异有统计学意义(P<0.05)。【结论】比伐卢定起效快,失效也快,能显著减低出血事件发生率,且不增加MACE发生率,用于高龄STEMI患者急诊PCI术中抗凝是安全、有效的。

[Objective] To evaluate the efficacy and safety of bivalirudin in elderly patients with acute ST-elevation myocardial infarc- tion （STEMI） undergoing emergency percutaueous coronary intervention （PCI）. [ Methods ] A total of 80 inpatients aged more than 75 with STEMI undergoing emergency PCI were consecutively enrolled. They were randomly divided into hivalirudin group （n=40） and hep- arin group （n=40）. Before the PCI, patients in the bivalirudiu group were treated with intravenous bivalirudin （0.75 mg/kg） followed by continuous infusion [1.75 rag＂ （kg＂ h）-~] for 4 h, while those in the heparin group received 130 IU/kg hepariu for anticoagulatiou. The an- ticoagulant efficacy at different time points was compared between the two groups after the treatment, The incidence of major adverse cardiovascular events （MACE） and bleeding complications was observed in the inpatients of both groups. [ Results] There was no sig- nificant difference in baseline characteristics of clinical data between the two groups in admission （P 〉 0.05）. The activated clotting time （ACT） at 5 min after the treatment reached the anticoagulafion standard （〉225 s） of PCI in both groups; the ACT in the hivafirudin group was significantly lower than that in the heparin group at 30 min, l h and 2 h after the drug withdrawal （P〈0.05）. There was no significant difference in the incidence of MACE between the two groups （P 〉 0.05）, while the incidence of bleeding complications in the bivalirudin group was markedly lower than that in the heparin group （P〈0.05）.[Conclusion] Bivalirudin with quick validation and invalidation can significantly reduce the incidence of bleeding complications without increasing the incidence of MACE. Therefore, it is safe and effec- tive in elderly patients with STEMI undergoing emergency PCI.