急性心肌梗死患者经皮冠状动脉介入术后输注不同剂量比伐卢定的疗效与安全性

Efficacy and safety of infusion of bivalirudin with different doses in patients with acute myocardial infarction after percutaneous coronary intervention

目的分析急性心肌梗死患者经皮冠状动脉介入术(PCI)后输注不同剂量比伐卢定的疗效与安全性。方法将急诊行PCI的81例急性心肌梗死患者随机分为全剂量组、低剂量组和对照组,每组27例。PCI后,对照组给予皮下注射低分子肝素钙;全剂量组给予比伐卢定1.75 mg/(kg·h)治疗4 h,0.25 mg/(kg·h)治疗20 h;低剂量组给予比伐卢定0.25 mg/(kg·h)治疗24 h。比较3组患者PCI前后心功能情况、凝血指标,住院期间出血情况以及术后6个月无主要不良心脑血管事件(MACCE)生存率。结果术后30 d,3组患者左心室射血分数、E峰与A峰比值均高于术前(均P<0.05),且对照组、低剂量组、全剂量组上述指标均依次升高(均P<0.05)。术后24 h,3组患者凝血酶原时间(PT)及活化部分凝血活酶时间(APTT)较术前延长,而纤维蛋白原(FIB)水平低于术前;对照组、低剂量组、全剂量组PT和APTT依次延长,而FIB水平依次降低(均P<0.05)。3组患者PCI后出血发生率差异无统计学意义(P>0.05)。全剂量组患者的6个月无MACCE生存率高于低剂量组和对照组(P<0.05),而低剂量组和对照组间差异无统计学意义(P>0.05)。结论PCI后使用比伐卢定可以改善患者心功能及血凝状态,且全剂量使用比伐卢定不会增加出血风险,并可更好地改善患者的预后。

Objective To analyze the efficacy and safety of infusion of bivalirudin with different doses in patients with acute myocardial infarction afteRpercutaneous coronary intervention(PCI).Methods Eighty-one patients with acute myocardial infarction who underwent emergency PCI were randomized to full-dose group,low-dose group oRcontrol group,with 27 cases in each group.AfteRPCI,the control group was subcutaneously injected with low-molecular-weight heparin calcium;the full-dose group received bivalirudin 1.75 mg/(kg·h)foR4 hours followed by 0.25 mg/(kg·h)foR20 hours;the low-dose group received bivalirudin 0.25 mg/(kg·h)foR 24 hours.Cardiac function and coagulation parameters before and afteRPCI,incidence of bleeding during hospitalization,as well as survival rate without majoRadverse cardiac and cerebrovasculaRevents(MACCE)afteR6 month of operation,were compared among the three groups.Results Thirty days afteRPCI,the left ventriculaRejection fraction and the ratio of peak E-wave velocity to peak A-wave velocity in the three groups were significantly higheRthan those before PCI(all P<0.05),and the indexes mentioned above increased in the ordeRof the control group,the low-dose group and the full-dose group(all P<0.05).Twenty-fouRhours afteRPCI,the three groups yielded longeRprothrombin time(PT)and activated partial thromboplastin time(APTT),as well as a loweRfibrinogen(FIB)level as compared with preoperation;PT and APTT were prolonged,whereas FIB level decreased in the ordeRof the control group,the low-dose group and the full-dose group(all P<0.05).There was no statistically significant difference in incidence rate of bleeding afteRPCI among the three groups(P>0.05).The 6-month survival rate without MACCE in the full-dose group was higheRthan that in the low-dose group oRcontrol group(P<0.05),but no statistically significant difference was observed between the low-dose group and the control group(P>0.05).Conclusion Application of bivalirudin afteRPCI can improve patients′cardiac function and coagulation status,and full-dose bivalirudine does not increase the risk of bleeding,and can effectively improve the prognosis of patients.