经皮冠状动脉介入治疗术中比伐卢定对急性ST段抬高性心肌梗死患者凝血功能的影响  

Effect of bivalirudin on coagulation of ST-segment elevted myocardial infarction patients in percutaneous coronary intervention

作　　者：岳继华[1] 孙婧[1] 杨国红[1] 刘军翔[1] 赵季红[1] 姜铁民[1] 

机构地区：[1]武警后勤学院附属医院心脏医院,天津300162

出　　处：《武警后勤学院学报（医学版）》2015年第9期710-712,共3页Journal of Logistics University of PAP（Medical Sciences）

摘　　要：【目的】探讨急诊冠脉介入术中应用比伐卢定对急性ST段抬高性心肌梗死(ST-segment elevted myocardial infarction,STEMI)患者凝血功能的影响。【方法】选择90例STEMI行急诊介入治疗(percutaneous coronary intervention,PCI)的患者,随机分为肝素组40例和比伐卢定组50例,分别用肝素钙或国产注射用比伐卢定抗凝。于PCI术前、用药后5 min、术后即刻、停药后30 min、1 h、2 h测活化凝血时间(activation hemoglutination time,ACT)。【结果】比伐卢定组用药后5 min ACT均能达到PCI手术所要求的>225 s,而肝素组有3例患者未能达到要求,需要追加剂量。PCI术中两组均能维持ACT>225 s。停药后,比伐卢定组ACT恢复较肝素组快,停药后30 min、1 h、2 h的ACT值比伐卢定组均低于肝素组(P<0.05)。【结论】与常规肝素抗凝相比,国产比伐卢定作为抗凝剂应用于急性ST段抬高性心肌梗死患者急诊介入治疗中,起效更快,效果更强,而且半衰期更短。【Objective】To explore the coagulation effect of bivalirudin in patients with acute ST-segment elevation myocardial infarction（STEMI） during emergency percutaneous coronary intervention（PCI）.【Methods】Ninety patients with STEMI by emergency PCI were randomly divided into 2 groups： heparin group（intravenous heparin calcium, n=40） and bivalirudin group（domestic intravenous bivalirudin, n=50）. Activated clotting time（ACT） was tested before PCI, 5 min after drug administration, instantly after PCI, 30 min, 1 h and 2 h after drug withdrawal.【Results】The ACT of 5 min after drug administration in bivalirudin group was longer than 225 s, while 3 cases in heparin group couldn＇t reach the level and need a dose increase. During PCI, the ACT in both groups was longer than 225 s. After drug withdrawal, ACT in bivalirudin group came back more rapidly than that in heparin group. The ACT levels of 30 min, 1 h and 2 h after drug withdrawal in bivalirudin group were shorter than those in heparin group（P〈0.05）.【Conclusion】Compared with conventional heparin, domestic bivalirudin in treating patients with STEMI during PCI is characterized by faster onset, stronger effect and shorter half life.

关 键 词：比伐卢定 急性ST段抬高性心肌梗死 经皮冠状动脉介入治疗 活化凝血时间 

分 类 号：R541.4[医药卫生—心血管疾病]