比伐卢定联合替罗非班在高血栓负荷急性心肌梗死介入治疗中的安全性和有效性研究

Safety and efficacy of bivalirudine combined with tirofiban in the interventional treatment of acute myocardial infarction with high thrombus load

目的探讨比伐卢定联合替罗非班在高血栓负荷急性心肌梗死患者介入治疗中的安全性和有效性。方法选取2018年5月至2020年5月菏泽市立医院心内科收治的120例接受直接经皮冠状动脉介入术治疗的高血栓负荷急性心肌梗死患者,男70例,女50例,年龄(62.58±4.11)岁,年龄范围为48~73岁。采取随机数表法将所有患者随机分为肝素联合替罗非班组与比伐卢定联合替罗非班组,每组60例。比伐卢定联合替罗非班组给予比伐卢定联合替罗非班治疗,肝素联合替罗非班组给予肝素联合替罗非班治疗。对两组患者手术前后心肌梗死溶栓治疗(TIMI)血流分级,血清P-选择素水平,术后24 h和术后30 d急性、亚急性支架内血栓事件及术后30 d不良心血管事件的发生率进行比较。结果两组患者术后的TIMI血流分级比较,差异无统计学意义(P>0.05)。比伐卢定联合替罗非班组术中及术后血清P-选择素水平[(8.07±3.21)pg/ml、(9.08±3.44)pg/ml]均低于肝素联合替罗非班组[(12.85±5.44)pg/ml、(11.31±3.76)pg/ml],差异有统计学意义(P<0.05)。两组患者术后24 h和30 d均无内急性、亚急性支架内血栓事件发生。肝素联合替罗非班组术后30 d不良心血管事件发生率(3.3%)与比伐卢定联合替罗非班组(5.0%)比较,差异无统计学意义(P>0.05)。结论比伐卢定联合替罗非班在高血栓负荷急性心肌梗死患者介入治疗中可有效改善TIMI血流分级,调节血清P-选择素水平,不增加支架内血栓事件及不良心血管事件发生率。

Objective To investigate the safety and efficacy of bivalirudine combined with tirofiban in the interventional therapy of acute myocardial infarction patients with high thrombus load.Methods A total of 120 patients with acute myocardial infarction with high thrombus load who received direct percutaneous coronary intervention were selected from the department of Cardiology of Heze Municipal Hospital from May 2018 to May 2020.There were 70 males and 50 females,aged(62.58±4.11)years old,ranging from 48 to 73 years old.All patients were randomly divided into heparin combined with tirofiban group and bivalirudin combined with tirofiban group by random number table method,with 60 cases in each group.The bivalaludine combined with tirofiban group was treated with bivalaludine combined with tirofiban,and the heparin combined with tirofiban group was treated with heparin combined with thrombolysis in myocardial infarction(TIMI),serum P-selectin level,the incidence of acute and subacute stent thrombus events at 24 h and 30 d postoperatively,and adverse cardiovascular events at 30 d postoperatively in two groups were compared before and after operation.Results There was no significant difference in TIMI blood flow grading between the two groups after operation(P>0.05).The serum level of P-selectin in bivalirudin combined with tirofiban group during and after operation[(8.07±3.21)pg/ml,(9.08±3.44)pg/ml]was lower than that in heparin combined with tirofiban group[(12.85±5.44)pg/ml,(11.31±3.76)pg/ml],and the difference was statistically significant(P<0.05).No acute or subacute intrastent thrombus events occurred in the two groups at 24 h and 30 d after surgery.There was no significant difference in the incidence of adverse cardiovascular events at 30 days after surgery between the heparin combined with tirofiban group(3.3%)and the bivalirudin combined with tirofiban group(5.0%),(P>0.05).Conclusion The bivalirudine combined with tirofiban can effectively improve TIMI blood flow grade and regulate serum P-selectin level in the patients of acute myocardial infarction with high thrombotic load during interventional therapy,but doesn′t increase the incidence of stent thrombus events and adverse cardiovascular events.