老年ST段抬高型心肌梗死患者行急诊冠状动脉介入治疗中应用比伐卢定有效及安全性的观察

To observe the efficacy and safety of bivalirudin in elderly patients with ST segment elevation myocardial infarction undergoing emergency percutaneous coronary intervention

目的:探究老年急性ST段抬高型心肌梗死(STEMI)患者实施急诊冠状动脉经皮介入术(PCI)前比伐卢定的应用效果及安全性。方法:选取2018年1至12月,沧县医院急诊行PCI手术的78例STEMI患者为研究对象,采用随机数字表法将其分为两组,对照组39例术前应用普通肝素进行抗凝治疗,观察组39例术前采用比伐卢定进行抗凝治疗。比较两组患者术后即刻心肌梗死溶栓治疗(TIMI)血流分级,术前、用药5 min、用药30 min、术后即刻、停药30 min、停药2 h的全血激活凝固时间(ACT),及住院期间主要心脏不良事件(MACE)、出血并发症发生情况等。结果:术后即刻TIMI血流分级两组患者比较,异无统计学意义(P>0.05);术前、用药30 min、术后即刻两组ACT水平比较,差异无统计学意义(P>0.05),但停药30 min、停药2 h观察组ACT水平显著低于对照组(P<0.05);住院期间MACE发生率观察组20.5%低于对照组25.6%,差异无统计学意义(P>0.05);住院期间出血发生率观察组23.1%显著低于对照组46.2%(P<0.05)。结论:比伐卢定能有效降低老年STEMI患者行PCI术后的出血率,且治疗效果与普通肝素无差异,值得临床推广应用。

Objective:To investigate the therapeutic effect and safety of bivalirudin in emergency percutaneous coronary intervention(PCI)in elderly patients with acute ST segment elevation myocardial infarction(STEMI).Methods:78 STEMI patients who underwent emergency PCI in cangxian hospital from January to December 2018 were selected as study subjects.They were divided into two groups by random number table method.39 cases in the control group were treated with heparin and 39 cases in the test group were treated with bivalirudin.Compare the two groups of patients with of thrombolysis in myocardial infarction(TIMI)blood flow grades immediately after surgery,and the activated coagulation time(ACT)of whole blood before,5 minutes after,30 minutes after,30 minutes after,2 hours after operation,and major adverse cardiac events(MACE),the occurrence of Bleeding complications.Results:there was no significant difference in TIMI blood flow grading between the two groups(P>0.05);there was no significant difference in ATC levels between the two groups before surgery,30 minutes after medication,and immediately after surgery(P>0.05),but the ATC level in the test group was significantly lower than that in the control group after the drug was stopped for 30 minutes and 2 hours(P<0.05);During hospitalization,the incidence of MACE in the test group was 20.5%,which was lower than the control group of 25.6%,but the difference was not statistically significant(P>0.05);the incidence of bleeding in the test group was 23.1%,which was significantly lower than the control group at 46.2%(P<0.05).Conclusions:bivalirudin can effectively reduce the bleeding rate of elderly STEMI patients after PCI,and there is no difference between the therapeutic effect and unfractionated heparin,which is worthy of clinical application.