治疗ACS急诊PCL患者临床疗效及安全性观察

Clinical observation on the efficacy and safety of bivalirudin combined with half dose of tirofiban in treating ACS emergency patients with PCI

目的:观察比伐芦定联用半量替罗非班在急性冠脉综合征(ACS)患者急诊经皮冠状动脉介入治疗(PCI)术中应用的有效性、安全性。方法:回顾性调查我院2013年1月-2016年8月因ACS就诊并行急诊PCI术的患者,术中血栓负荷重并使用比伐芦定或肝素联用半剂量替罗非班抗栓者212例,根据使用抗栓方案不同分为比伐芦定+半量替罗非班组及肝素+半量替罗非班组。分析比较两组一般情况、冠脉影像特点等一系列基线资料,观察两组心功能情况、术中TIMI血流的变化、术后出血和30d内的主要心血管不良事件(MACE)的发生情况进行随访统计,分析比较其中差异。结果:比伐芦定+半剂量替罗非班组(n=119)与肝素+半量替罗非班组(n=93)比较,TIMI血流情况、心功能情况、术后30 d MACE发生率(支架内血栓、再次心肌梗死、卒中、死亡)两组差异无统计学意义(P均>0.05),术后6h、72h、30d内的出血事件发生率,比伐芦定组低于肝素组,两组差异有统计学意义(P<0.05)。结论:比伐芦定联用半量替罗非班应用于ACS患者急诊PCI术中是安全有效的,其疗效与肝素+半量替罗非班组相比较差异无统计学意义,但出血风险降低,安全性提高。

Objective:To observe the efficacy and safety of bivalirudin combined with half dose of tirofiban on emergency percutaneous coronary intervention(PCI)in patients with acute coronary syndrome(ACS).Method:A retrospective survey on emergency PCI patients underwent ACS treatment was made,the thrombus burden and t bivalirudin or heparin combined with half dose tirofiban was applied in anti thrombus in212cases;the patients were divided into bivalirudin combined with half dose tirofiban group and half dose of heparin plus tirofiban group.Result:Bivalirudin combined with half dose tirofiban group(n=119)and heparin combined with half dose tirofiban group(n=93)were compared,TIMI blood flow,heart function,postoperative30day incidence of MACE(stent thrombosis,myocardial infarction,stroke,death again)of two group were of no statistically significant difference(P>0.05),the incidence of bleeding events within30d,6hours,72hours after the surgery of the bivalirudin group was lower than that of heparin group,there was significant difference between two groups(P<0.05).Conclusion:It was safe and effective to apply bivalirudin combined with half dose tirofiban in treating emergency percutaneous coronary intervention(PCI)in patients with acute coronary syndrome(ACS),the efficacy of which was of no statistical difference compared with that of half dose of heparin plus tirofiban group,but the risk of bleeding was reduced,the security was improved.