替罗非班联合磺达肝癸钠对改善急性冠状动脉综合征合并轻度肾功能不全患者PCI预后的应用价值

The clinical value of tirofiban combined with fondaparinux in improving prognosis of patients with acute coronary syndrome and mild renal insufficiency

目的 评估在经皮冠状动脉介入治疗(PCI)围手术期联合应用替罗非班和磺达肝癸钠对改善急性冠状动脉综合征(ACS)合并轻度肾功能不全(CKD 2期)患者短期和远期预后的临床价值.方法 选取2015年1月至2016年12月在我院接受PCI介入治疗的142例ACS合并CKD2期患者,按随机数字表分为替罗非班治疗组(47例)、磺达肝癸钠治疗组(48例)、替罗非班与磺达肝癸钠联用组(47例),在PCI介入术后分别予以对应药物治疗.比较各组患者用药前后的凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)和血小板计数(PLC),以及PCI介入术后7 d、30 d出血事件发生率.同时以1年内发生主要心血管不良事件作为远期观察指标.结果 替罗非班组和磺达肝癸钠组患者在用药后的PT、APTT均高于用药前、而PLC低于用药前,具有统计学意义;但联用组患者的用药前后的PT、APTT和PLC无明显改变.联用组患者术后7 d和30 d的轻度出血发生率均显著低于替罗非班治疗组和磺达肝癸钠治疗组,分别为(4.3%与19.1%,16.7%)和(6.4%与25.5%,20.8%),差异具有统计学意义(P<0.05).联用组患者1年内并发症防控的有效率显著高于替罗非班治疗组和磺达肝癸钠治疗组,分别为(87.2%与51.1%,56.3%),并且心血管不良事件发生率显著低于替罗非班治疗组和磺达肝癸钠治疗组,分别为(2.1%与12.8%,14.6%),差异均存在统计学意义(P<0.05).结论 合并CKD 2期的ACS患者在PCI围手术期联合应用替罗非班和磺达肝癸钠能够有效预防PCI术后出血和心血管不良事件的发生.

Objective To evaluate the short-term and long-term outcomes of tirofiban combined with fondaparinux in the perioperative period of percutaneous coronary intervention(PCI)in the treatment of patients with acute coronary syndrome(ACS)with mild renal insufficiency(CKD stage 2).Methods A total of 142 patients with ACS and CKD stage 2 who underwent PCI in our hospital from January 2015 to December 2016 were randomly divided in-to three groups:tirofiban group(47 cases),fondaparinux group(48 cases)and combination group(47 cases),and each groups were treated with the corresponding drug after PCI intervention.The prothrombin time(PT),partial activated thromboplastin time(APTT)and platelet counts(PLC)before and after drug treatment were compared between all groups.The incidence of hemorrhage occurred at 7 days and 30 days after PCI as the short-term outcomes,and the major cardiovascular adverse events within one year as the long-term outcomes were compared.Results PT and APTT of patients in tirofiban group and fondaparinux group after the drug admission were significantly higher than those before drug treatment,while PLC was significantly lower than that of before treatment,but there were no significant changes in combination group.The incidence of mild bleeding at 7 days and 30 days after PCI in combination group were significantly lower than those in tirofiban group and fondaparinux group(4.3%vs 19.1%,16.7%,respectively)and(6.4%vs 25.5%,20.8%,respectively),respectively,both of which were statistically significant(P<0.05).The effective rate of complication prevention in the combination group was significantly higher than that of tirofiban group and fondaparinux group(87.2%vs 51.1%,56.3%,respectively),and the major cardiovascular adverse events was significantly lower than that of tirofiban group and fondaparinux group(2.1%vs 12.8%,14.6%,respectively),both of which were statistically significant(P<0.05).Conclusion Combination with tirofiban and fondaparinux in the perioperative period of PCI can effectively prevent the occurrence of postoperative bleeding and cardiovascular adverse events after PCI in ACS patients with CKD Stage 2.