高SYNTAX评分的急性心肌梗死PCI围手术期应用比伐卢定的价值分析

Value of PCI perioperative application of bivaludin in patients with acute myocardial infarction with high SYNTAX score

目的通过对高SYNTAX评分急性心肌梗死患者PCI围手术期应用比伐卢定的效益-风险分析,探讨比伐卢定在AMI患者PCI手术治疗中的使用价值。方法选择重庆三峡医药高等专科学校附属中医院2020年2月至2022年2月期间收治的141例高SYNTAX评分的AMI患者作为研究对象,根据PCI围手术期应用不同抗凝药物将患者分成两组,应用比伐卢定的68例患者纳入研究组,应用普通肝素的73例患者纳入对照组。对两组患者一般资料、心功能指标、心血管不良事件及出血事件等进行比较。建立高SYNTAX评分的AMI患者PCI围手术期应用比伐卢定的效益与风险多准则决策分析模型。利用RevMan 5.3将数据进行合并,得出各效益指标和风险指标效应值,利用Hiview 3分析研究组和对照组的风险值、效益值和效益-风险总值,并分析模型的灵敏度。结果两组患者治疗前后PLT的差异均不显著(P>0.05),研究组患者治疗后的LVESD、LVEDD、NT-proBNP、总心血管不良事件、出血及血栓均显著低于对照组(P<0.05),而治疗后的ACT、LVEF及总有效率均显著高于对照组(P<0.05);研究组和对照组的效益值分别为79、63,风险值分别为70,36,效益-风险总值分别为75,50。研究组的效益-风险总值更高。无论效益-风险的相对权重如何改变,模型评价结果均保持不变,表明该模型稳定型良好。结论对于高SYNTAX评分的AMI患者在PCI围手术期使用比伐卢定进行抗凝治疗,可获得良好的临床疗效,提升患者心功能,降低不良反应的发生,可作为普通肝素的替代药物在临床推广。

Objective To investigate the value of bivalirudin perioperative PCI use in patients with acute myocardial infarction(AMI)with high SYNTAX score.Methods A total of 141 patients with AMI with high SYNTAX score admitted to our hospital from February 2020 to February 2022 were selected as the study objects.The patients were divided into two groups according to PCI perioperative application of different anticoagulant drugs.68 patients receiving bivalirudin were included in the study group,and 73 patients receiving ordinary heparin were included in the control group.The general data,cardiac function indexes,cardiovascular adverse events and bleeding events were compared between the two groups.A multi-criteria decision analysis model was established for the benefit and risk of perioperative application of bivalirudin in AMI patients with high SYNTAX score.The data were combined by RevMan 5.3 to obtain the effect values of each benefit index and risk index.Hiview 3 was used to analyze the risk value,benefit value and benefit-total risk value of 2 groups,and to analyze the sensitivity of the model.Results There was no significant difference in PLT between the two groups before and after the treatment(P>0.05).LVESD,LVEDD and NT-proBNP of the study group were significantly lower than those of the control group after the treatment(P<0.05).After the treatment,ACT,LVEF,total effective rate,total cardiovascular adverse events and total bleeding events in the study group were significantly higher than those in the control group(P<0.05).The benefit values,the risk values and the benefit-risk total values of 2 groups were 79 and 63,70 and 36 and 75 and 50 respectively.The study group had a higher benefit-risk ratio.No matter how the relative weight of benefit-risk changes,the evaluation results of the model remained unchanged,indicating that the model had a good stability.Conclusion For AMI patients with high SYNTAX score,anticoagulant treatment with bivalirudin during perioperative period of PCI can obtain good clinical efficacy,improve patients’cardiac function and reduce the occurrence of adverse reactions and can be promoted clinically as a substitute for ordinary heparin.