比伐卢定对急诊PCI患者血小板功能及炎症因子的影响

The influence of bivalirudin on platelet function and inflammatory factor of patients undergoing emergency PCI

目的观察比伐卢定对急诊PCI患者血小板聚集及活化能力及血清炎症因子水平。方法收集2016年—2017年在作者所在医院就诊并行急诊PCI术治疗的急性STEMI住院发病时间<12 h患者120例,随机分为两组,分别应用不同的抗凝药物即比伐卢定组和替罗非班加肝素组,两组分别将60例患者纳入最终荟萃分析。比伐卢定组:球囊扩张罪犯血管(Culprit Artery)病变后,静脉注射0.75 mg/kg负荷量的比伐卢定,在3～5 min内推注完毕后再植入支架。术后继续给予1.75 mg/kg·h的维持量微量泵泵入4 h。替罗非班加肝素组:术前静脉内注射10μg/kg负荷剂量替罗非班,同时再注射普通肝素100 U/kg,然后以约0.75μg/kg·min的滴速持续24～36 h静脉泵入替罗非班。比较两组患者PCI术前、术后血小板活化及血清炎症因子的变化。结果两组患者PCI术后血清P选择素较术前降低,而GMP-140、PTX-3水平均较术前升高差异有统计学意义(P<0.05),两组间比较各因子浓度均无统计学意义(P>0.05)。结论比伐卢定除具有抗凝作用外,可能与替罗非班一样都具有抗炎症反应的作用。

Objective To compare and analyse the influence resulted from bivalirudin and tirofiban in patients with ST-segment elevation myocardial infarction undergoing emergency PCI.Methods A numberl of 120 patients who suffered from STEMI and received emergency PCI were randomly divided into tirofiban plus heparin group and bivalirudin group,respectively 60 cases in each group.the patients of bivalirudin group received bivalirudin 0.75mg/kg,followed by an infusion of bivalirudin 1.75mg/kg·h continuing 4 hours,while tirofiban plus heparin group,patients received tirofiban 10μg/kg,followed by tirofiban infusion of 0.075μg/kg·min for 36 hours,while taken heparin 100units/kg during PCI procedure.The patients were compared through P selectin GMP-140,PTX-3 level.Results After PCI serum P selectin was lower than before operation,while GMP-140,PTX-3 levels were higher than the preoperative(P<0.05),between the two groups P selectin,GMP-140,PTX-3 levels were not statistically significant(P>0.05).Conclusion In patients undergoing emergency PCI,bivalirudin may have anti-inflammatory effects as well as tirofiban besides anticoagulant effect.