冠状动脉内应用比伐卢定对急性非ST段抬高型心肌梗死高危患者早期PCI术预后的影响

Effect of intracoronary bivaludin on prognosis of early PCI in high-risk patients with acute non-ST-segment elevation myocardial infarction

目的观察冠状动脉内注射比伐卢定对急性非ST段抬高型心肌梗死(NSTEMI)高危患者早期行经皮冠状动脉介入治疗(PCI)术预后的影响。方法 选择2016年1月—2018年8月邢台市第三医院心内科诊治的NSTEMI高危患者115例作为研究对象,采用随机数字表法分为对照组58例、观察组57例。患者均按照冠心病诊疗规范治疗并予PCI;术中对照组患者给予肝素钠注射液抗凝,观察组给予比伐卢定抗凝至术后4 h。比较2组患者罪犯血管术前、术后校正的心肌梗死溶栓(TIMI)血流计帧数(CTFC)、活化凝血时间(ACT)、血清氨基末端脑钠肽前体(NT-proBNP)浓度、心电图QRS波时限、心脏超声结果及不良事件发生率。结果 术后观察组患者罪犯靶血管CTFC明显低于对照组( t/P =2.429/0.027);2组患者术后ACT检测值差异均无统计学意义( P >0.05);2组患者术前心电图QRS波时限、心脏超声左室射血分数(LVEF)、左室舒张末期内径(LVEDD)、室间隔厚度(IVSd)、血清NT-proBNP含量比较,差异均无统计学意义( P >0.05);术后90 d时观察组患者QRS波时限、血清NT-proBNP低于对照组( t/P =2.019/0.042,2.461/0.037),随访90 d不良事件发生率低于对照组患者(χ 2/ P =4.294/0.045)。术后180 d,观察组、对照组患者左室射血分数均高于术前,且观察组较对照组明显升高( t =4.748,2.027,2.239, P =0.000,0.035, 0.039 );另外,术后180d观察组左室舒张末内径(LVEDD)、室间隔厚度(IVSd)明显低于对照组( t =1.985,2.223, P =0.049,0.039)。结论 冠状动脉内应用比伐卢定可进一步改善NSTEMI高危患者早期PCI术的预后,值得临床推广应用。

Objective To observe the effect of intracoronary bivalrudine injection on the prognosis of early percutaneous coronary intervention(PCI)in high-risk patients with acute non-ST-segment elevation myocardial infarction(NSTEMI).Methods A total of 1 15 high-risk NSTEMI patients were selected from the Department of Cardiology,Xingtai City Third Hospital from January 2016 to August 2018.The randomized digital table method was divided into 58 cases in the control group and 57 cases in the observation group.All patients were treated according to the criteria of coronary heart disease treatment and PCI.In the control group,heparin sodium injection was given anticoagulation,and the observation group was given bivalirudin anticoagulation until 4 hours after operation.The myocardial infarction thrombolysis(TIMI)blood flow meter frame number(CTFC),activated clotting time(ACT),serum amino terminal brain natriuretic peptide(NT-proBNP)concentration were compared between the two groups of patients before and after surgery.ECG QRS wave time limit,cardiac ultrasound results and incidence of adverse events.Results The CTFC of target blood vessels in the obstervation group was signifiantly lower than that in the control group(t/P =2.429/0.027).There was no significant difference in the postoperative ACT between the two groups(P>0.05).The preoperative electrocardiogram of the two groups was observed.There were no signifficant differences in QRS duration,left ventricular ejection fraction(LVEF),left ventricular end diastolic diameter(LVEDD),interventricular septum thickness(IVSd),and serum NT proBNP(P>0.05).At the 90 th day,the QRS duration and serum NT proBNP were lower in the observation group than in the control group(t/P=2.019/0.042,t/P=2.461/0.037),the incidence of adverse events was lower than that of the control group at 90 days of follow-up(x^2/P=4.294/0.045).The LVEF of the two groups 180 days after PCI were significantly higher than that of before treatment(t=4.748,2.027,2.239,P= 0.000,0.035,0.039,);The LVEDD,IVSd of observation group was significantly lower than that of the control group(t = 1.985,2.223,P = 0.049,0.039)180 days after PCI.Conclusion Intracoronary bivalirudin can further improve the prognosis of early PCI in NSTEMI high-risk patients,which is worthy of clinical application.