摘要
目的探讨在非ST段抬高型急性冠脉综合征(NSTE-ACS)人群中,经皮冠状动脉介入(PCI)术后延时应用比伐芦定的安全性和有效性。方法选取2016年1月至2017年1月在煤炭总医院心内科住院的NSTE-ACS患者中行冠状动脉造影且符合PCI条件者105例,分为普通肝素组44例(A组),比伐芦定常规组33例(B组)和比伐芦定延时组28例(C组)。出院后进行1次随访(PCI术后30 d),记录出血事件、急性支架内血栓和主要心血管不良事件(MACE)。结果 3组患者年龄、GRACE评分高危患者比较,差异均有统计学意义(P<0.01)。3组间冠脉病变支数比较,差异有统计学意义(P<0.05),其中,B组冠脉造影三支病变比例明显高于A组(P<0.05)。3组间术后总出血事件比较,差异有统计学意义(P<0.05),A组总出血事件发生率显著高于B组和C组(P<0.05)。3组间术后2~5型出血事件及3~5型出血事件发生率比较,差异无统计学意义(P>0.05)。术后30 d随访,A组有2例MACE事件,包括1例消化道大出血死亡和1例非致死性急性心肌梗死;B组有1例急性支架内血栓形成经抢救成功存活;C组无MACE事件。A组发生1例PCI术后血小板减少。3组间MACE事件、血小板减少症、急性支架内血栓发生率比较,差异无统计学意义(P>0.05)。3组患者术后均多点检测激活全血凝固时间(ACT),术后即刻、停药后30 min及2 h的ACT数值比较,差异均有统计学意义(P<0.05)。结论对于NSTE-ACS人群中,PCI术后延时应用比伐芦定是安全、有效。
Objective To evaluate the safety and efficacy of prolonged bivalirudin infusion for NSTE-ACS patients after percutaneous coronary intervention(PCI).Methods A retrospective study was performed on 105 cases of patients with NSTE-ACS who were admitted and performed PCI from January 2016 to January 2017.Patients were divided into the unfractionated heparin group(Group A,n =44),routine use of bivalirudin group(Group B,n = 33) and prolonged bivalirudin group(Group C,n = 28).The bleeding events,MACE and acute in-stent thrombosis events were observed and recorded during hospitalization and first follow-up in 30 days after PCI.Results There were statistically significant differences among the three groups in age,GRACE score of high-risk patients rates(P〈0.01) and the number of coronary artery lesions in the three groups(P〈0.05),the rate of triple branch lesions in Group B was significantly higher than that of Group A(P〈0.05).The rate of total bleeding events in Group A was significantly higher than that of Group B and Group C(P〈0.05).There were no significant differences among the three groups in the rates of 2 to 5 type bleeding and 3 to5 type bleeding(P〈0.05).During follow-up in 30 days,there were 2 cases of MACE in Group A,including 1 case of death of massive digestive tract hemorrhage and 1 case of non-fatal acute myocardial infarction;there was 1 case with acute in-stent thrombosis in Group B,and there was no case of MACE in Group C.There was 1 case of PCI postoperative thrombocytopenia in Group A.There were no significant differences in the rates of MACE,thrombocytopenia and acute in-stent thrombosis among the three groups(P〈0.05).There were statistically significant differences in the values of ACT immediately after PCI,30 minutes and 2 hours after PCI and drug withdrawal among the three groups(P〈0.05).Conclusion It is safe and effective to prolong bivalirudin infusion for NSTE-ACS patients after PCI.
出处
《临床军医杂志》
CAS
2017年第11期1105-1109,共5页
Clinical Journal of Medical Officers
基金
"十二五"国家科技支撑计划课题(2012BAI37B05)
关键词
非ST段抬高型急性冠脉综合征
经皮冠状动脉介入
比伐芦定
延时给药
non-ST segment elevation acute coronary syndrome
percutaneous coronary intervention
Bivalirudin
Prolongedinfusion