比伐卢定在STEMI患者直接PCI治疗中有效性及安全性的研究

Efficacy and safety study of Bivalirudin therapy in STEMI patients undergoing emergency PCI

目的观察比伐卢定在急性ST段抬高型心肌梗死(STEMI)患者急诊PCI治疗中的疗效和安全性。方法随机选择2014年8月~2015年2月在我院急诊行PCI术的80例STEMI患者,随机分为观察组和对照组,各40例。观察组在PCI期间应用比伐卢定抗凝治疗,对照组应用普通肝素治疗。观察两组的梗死相关动脉PCI术后即刻TIMI血流、TMPG分级,比较两组的心电图ST段回落、左室射血分数值、左室舒张末期内径及住院期间的主要心血管事件及出血和血小板减少发生率。结果两组的TIMI血流分级、TMPG分级比较,差异均无统计学意义(P>0.05);观察组的心电图ST段回落、30 d左室射血分数值、左室舒张末期内径优于对照组,差异有统计学意义(P<0.05)。观察组的牙龈出血及血尿发生率高于对照组,差异有统计学意义(P<0.05)。两组30 d因心力衰竭再发心绞痛的住院率、不良反应发生率比较,差异均无统计学意义(P>0.05)。结论在STEMI患者急诊PCI治疗中应用比伐卢定具有较好的临床效果和安全性,比伐卢定可作为STEMI患者急诊PCI的常规抗凝治疗措施。

Objectve To observe the efficacy and safety of Bivalirudin therapy in STEMI patients undergoing emergency PCI.Methods 80 STEMI patients with emergency PCI from August 2014 to February 2015 in our hospital were randomly selected and randomly divided into the observation group and the control group,40 cases in each groups.The observation group was treated by Bivalirudin therapy during the period of PCI,and the control group was treated with unfractionated Heparin （UFH）.TIMI flow grade and myocardial perfusion grade （TMPG） were observed in the two groups post PCI.ST- segment of ECG, LVEF, left ventricular and diastolic diameter （LVEDD）,the incidence of major adverse cardiac event （MACE）, bleeding and the incidence of thrombocytopenia were compared between the two groups.Results There was no statistically significant difference in the TIMI flow grade or TMPG between the two groups （P〉0.05）.The ST-segment of ECG,the level of LVEF and LVEDD in 30 days after PCI in the observation group was better than that in the control group,with significant difference （P〈O.OS）.The incidence of gingival bleeding and hematuria in the observation group was higher than that in the control group,with significant difference （P〈0.05）.There was no significant difference between the two groups of 30 d in the hospitalization rate of recurrent angina pectoris because of heart failure and adverse reaction rate between the two groups （P〉0.05）.Conclusion In STEMI patients with emergency PCI,application of Bivalirudin is safe and effect.Bivalirudin can be used in emergency PCI in patients with STEMI conventional anticoagulant treatment measures.