冠脉内注射比伐卢定治疗急诊介入术中无复流的疗效

Therapeutic efficacy of intracoronary infusion of bivalirudin in the treatment of no-reflow during primary percutaneous coronary intervention

目的:探讨冠脉内注射比伐卢定治疗急性ST段抬高型心肌梗死(ST-segment elevation myocardial infarction,STEMI)患者急诊经皮冠状动脉介入治疗(percutaneous coronary intervention,PCI)术中冠状动脉无复流或慢血流(thrombolysis in myocardial infarction,TIMI)的疗效。方法:本研究为回顾性研究。连续收集2017年5月至2018年8月重庆医科大学附属永川医院心内科收治的行急诊PCI术中发生无复流或慢血流的STEMI患者32例(所有患者术中均常规静脉使用比伐卢定抗凝),根据术中治疗无复流的药物选择分为比伐卢定组(比伐卢定0.375 mg/kg,n=16)及对照组(硝普钠200μg,n=16),比较2组患者治疗后靶血管TIMI血流分级情况,以及术后住院期间出血及心血管不良事件、术后30 d主要心脏不良事件(major adverse cardiovascular events,MACE)的发生率。结果:与对照组相比,比伐卢定组术后靶血管TIMI 3级患者比例[12(75%)vs. 6(37.5%),P=0.033]明显增高,差异具有统计学意义(P<0.05);2组患者术后心血管不良事件对比无统计学差异(P>0.05);2组患者均未出现术后出血事件及术后30 d MACE事件。结论:冠脉内注射比伐卢定可改善STEMI患者急诊PCI术中无复流或慢血流,增加术后靶血管TIMI前向血流,且具有一定安全性。

Objective:To explore the therapeutic efficacy of intracoronary infusion of bivalirudin in the treatment of no-reflow or slow flow in coronary arteries during primary percutaneous coronary intervention(PPCI)in patients with acute ST-segment elevation myocardial infarction(STEMI).Methods:A retrospective analysis was performed for the clinical data of 32 STEMI patients with no-reflow or slow flow during PPCI,who were admitted to the department of cardiology at Yongchuan Hospital of Chongqing Medical University from May 2017 to August 2018.All these patients were given intravenous bivalirudin anticoagulant during PPCI.According to the choice of drugs for intraoperative treatment of no-reflow in coronary artery,the patients were divided into two groups:bivalirudin group(bivalirudin 0.375 mg/kg,n=16)and control group(sodium nitroprusside 200μg,n=16).The thrombolysis in myocardial infarction(TIMI)blood flow grade of target vessel after treatment,the incidence of postoperative hemorrhage and cardiovascular events during hospitalization and major adverse cardiac events(MACE)30 days after treatment were observed and compared between the two groups.Results:Compared with the control group,the bivalirudin group had a significantly increased proportion of TIMI grade 3 patients[12(75%)vs.6(37.5%),P<0.05],and there was no significant difference between the two groups in postoperative cardiovascular events(P>0.05).There were no postoperative bleeding and MACE 30 days after treatment in either group.Conclusion:Intracoronary infusion of bivalirdin,as a treatment with certain safety,can alleviate no-reflow or slow flow in patients with STEMI during primary PCI,and increase the forward flow of TIMI in target vessel after PCI.