比伐卢定和肝素在急诊冠脉介入治疗术中对血小板功能的影响

Effect of bivalirudin and heparin on platelet function in emergency percutaneous coronary intervention

目的探讨比伐卢定和肝素在急诊经皮冠状动脉介入治疗(PCI)术中对血小板功能的影响并比较两者安全性。方法将82例ST段抬高型心肌梗死(STEMI)患者随机分为比伐卢定组和肝素组,各41例。在PCI过程中,比伐卢定组静脉应用比伐卢定,肝素组用肝素抗凝。比较用药前、用药后10 min、用药结束、用药结束后1 h和用药结束后2 h的二磷酸腺苷(ADP)诱导的血小板最大聚集率、凝血酶原激活时间(ACT)和3个月的不良反应发生率。结果比伐卢定组用药后10 min、用药结束时血小板最大聚集率均低于用药前(P<0.01);肝素组用药后10 min,血小板最大聚集率高于用药前(P<0.05)。两组用药前后同期血小板最大聚集率比较,仅用药后10 min比伐卢定组低于肝素组(P<0.01)。用药10 min后,两组ACT值均明显上升(P<0.01);用药结束后,两组ACT值逐渐降低;结束2 h时,比伐卢定组降低至略低于用药前,肝素组仍高于用药前。两组用药前后ACT值同期比较,用药后10 min比伐卢定组高于肝素组(P<0.01);用药结束后1 h、用药结束后2 h比伐卢定组均低于肝素组(P<0.01)。比伐卢定组的不良反应发生率低于肝素组(P<0.05)。结论比伐卢定对PCI治疗STEMI患者的血小板功能的影响更显著,抗凝效果好,不良反应发生率低,安全性好。

Objective To compare the effects of bivalirudin and heparin on platelet function in the patients undergoing emergency percutaneous coronary intervention(PCI).Methods A total of 82 patients suffering from myocardial infarction with ST-segment elevation(STEMI)were randomized to bivalirudin group and heparin group.Bivalirudin was intravenously used to anticoagulation in bivalirudin group,while heparin was done in heparin group.Platelet aggregation rate induced by adenosine diphosphate(ADP),activated clotting time(ACT)and the incidence of adverse reaction were respectively compared between the two groups,at pre-medication,post-medication 10 minutes,1 hour and 2 hour and the end of medication.Results In the two groups,there existed significant differences in platelet aggregation rate at the end of medication and post-medication 10 minutes compared with those of pre-mediation(P<0.01).The pre-medication platelet aggregation rate was lower than that of the post-medication 10 minutes in heparin group.The ACTs of the both groups significantly decreased gradually,but that of bivalirudin group got a lower number than that of heparin group at post-medication 1 hour and 2 hours(P<0.01).The incidence of adverse reactions in heparin group was significantly higher than that in bivalirudin group(P<0.05).Conclusion Bivalirudin had a better anticoagulant,concurrent a lower incidence of adverse reactions in PCI for STEMI compared with heparin.