比伐卢定与肝素在高危急性冠脉综合征患者中应用效果的对比研究

Comparative Study for Application Effect in High-risk Acute Coronary Syndrome Patients between Bivalirudin and Heparin

目的比较比伐卢定与肝素在高危急性冠脉综合征(ACS)患者中的应用效果。方法选取2015年3月—2017年3月河北省第七人民医院收治的高危ACS患者94例,采用随机数字表法分为A组48例与B组46例。两组患者均行经皮冠状动脉介入术(PCI),A组患者术前予以比伐卢定治疗,B组患者术前予以肝素治疗。比较两组患者用药前、术后1 h凝血酶原时间(PT)、凝血酶时间(TT)及纤维蛋白原(FIB)水平,用药前、用药后5 min、手术完毕即刻、停药后30 min、停药后2 h活化凝血时间(ACT),用药前、术后1 d脑钠肽(BNP)、超敏C反应蛋白(hs-CRP)水平,并观察两组患者治疗期间出血发生情况。结果用药前、术后1 h两组患者PT、TT及FIB水平比较,差异无统计学意义(P>0.05)。时间与方法在ACT上存在交互作用(P<0.05);时间在ACT上主效应显著(P<0.05);方法在ACT上主效应显著(P<0.05);A组患者用药后5 min、手术完毕即刻ACT长于B组,停药后2 h ACT短于B组(P<0.05)。用药前两组患者BNP、hs-CRP水平比较,差异无统计学意义(P>0.05);术后1 dA组患者BNP、hs-CRP水平低于B组(P<0.05)。治疗期间A组患者出血发生率低于B组(P<0.05)。结论与肝素比较,比伐卢定在高危ACS患者中的应用效果较好,可更有效地改善患者凝血功能,降低BNP、hs-CRP水平,且安全性较高。

Objective To compare the application effect in high-risk acute coronary syndrome patients between bivalirudin and heparin.Methods A total of94high-risk acute coronary syndrome patients were selected in the Seventh Hospital of Hebei Province from March2015to March2017,and they were divided into A group(n=48)and B group(n=46)according to random number table.Patients in the two group received PCI,thereinto patients in A group received bivalirudin before PCI,patients in B group received heparin before PCI.PT,TT and FIB before medication and1hour after PCI,ACT before medication,5minutes after medication,immediately after PCI,30minutes and2hours after drug withdrawal,BNP and hs-CRP before medication and1day after PCI were compare between the two groups,and incidence of hemorrhage was observed during the treatment.Results No statistically significant differences of PT,TT or FIB was found between the two groups before medication or1hour after PCI(P>0.05).There was interaction between time and method in ACT(P<0.05);main effects of time and method were significant in ACT(P<0.05);ACT in A group was statistically significantly longer than that in B group5minutes after medication and immediately after PCI,respectively,while ACT in A group was statistically significantly shorter than that in B group2hours after drug withdrawal(P<0.05).No statistically significant differences of BNP or hs-CRP was found between the two groups before medication(P>0.05),while BNP and hs-CRP in A group were statistically significantly lower than those in B group1day after PCI(P<0.05).Incidence of hemorrhage in A group was statistically significantly lower than that in B group during the treatment(P<0.05).Conclusion Compared with heparin,bivalirudin has better application effect in high-risk acute coronary syndrome patients,can more effectively improve the coagulation function,reduce BNP and hs-CRP,with higher safety.