老年患者择期冠状动脉介入治疗中低剂量比伐卢定安全性观察  

The use of low-dose bivalirudin in elderly patients receiving elective percutaneous coronary intervention:observation of its safety

作　　者：曾松柏[1,2] 曾山[1] 张梅[1] 赵鹏[1] 

机构地区：[1]武警后勤学院附属医院心脏中心,天津300162 [2]河北医科大学研究生院

出　　处：《介入放射学杂志》2016年第3期250-253,共4页Journal of Interventional Radiology

摘　　要：目的探讨老年患者择期经皮冠状动脉介入治疗(PCI)中应用低剂量比伐卢定的安全性。方法连续选取年龄>65岁冠心病患者162例,随机分为标准剂量组(n=80)和低剂量组(n=82)。PCI术前两组患者接受静脉推注负荷剂量比伐卢定0.75 mg/kg,术中标准剂量组以1.75 mg·kg^(-1)·h^(-1)加术后0.2 mg·kg^(-1)·h^(-1)剂量持续给药2 h,低剂量组以1.5 mg·kg^(-1)·h^(-1)加术后0.15 mg·kg^(-1)·h^(-1)剂量持续给药2 h。对比分析两组患者给药后5 min、30 min、手术终止时、术后1 h活化凝血时间(ACT)值以及术后1个月内出血事件、心肌梗死、靶血管重建、支架内血栓、不明原因卒中发生率。结果低剂量组给药后30 min、手术终止时、术后1 h ACT值与标准剂量组相比均明显降低,分别为(331.2±53.5)s对(383.5±74.7)s、(324.9±47.6)s对(371.3±65.4)s、(289.6±34.9)s对(314.8±43.1)s,P值均<0.001。两组患者术后1个月内心肌梗死、一般出血事件发生率比较,差异均无统计学意义(P>0.05),未发生大出血、靶血管重建、支架内血栓和不明原因卒中事件。结论老年冠心病患者择期PCI术中应用低剂量比伐卢定抗凝。Objective To evaluate the safety of using of low-dose bivalirudin in elderly patients who receive elective percutaneous coronary intervention （PCI） for coronary artery disease （CAD）. Methods A total of 162 continuously encountered patients （〉65 years） with CAD were included in this study. The patients were randomly divided into standard dose group （group B, n=80） and low-dose group （group A, n=82）. Before PCI, an intravenous bolus injection of bivalirudin （0.75 mg/kg） was performed in all patients of both groups. For patients of group B, intraoperative use of 1.75 mg·kg^-1·h^-1 bivalirudin and postoperative use of 0.2 mg·kg^-1·h^-1 bivalirudin lasting for two hours were employed; while for patients of group A, intraoperative use of 1.5 mg·kg^-1·h^-1 bivalirudin and postoperative use of 0.15 mg·kg^-1·h^-1 bivalirudin lasting for two hours were adopted. The activated clotting time （ACT） was determined at 5 min, 30 min, the end-point of operation and 60 min after operation separately. The complications occurred within one month after PCI, such as bleeding event, myocardial infarction, target vessel revascularization, stent thrombosis and stroke of unknown origin, were recorded. The results were compared between the two groups. Results The ATC values determined at 30 min, the end-point of operation and 60 min after operation in the group A were significantly lower than those in the group B, the results being （331.2±53.5） s vs. （383.5±74.7） s, （324.9±47.6） s vs. （371.3±65.4） s and （289.6±34.9） s vs. （314.8±43.1） s, respectively （P〈0.001）. No significant differences in the incidences of myocardial infarction and general bleeding event within one month after PCI existed between the two groups （P〉0.05）, and no massive hemorrhage, target vessel revascularization, stent thrombosis and stroke of unknown origin occurred in both groups. Conclusion In treating elderly CAD patients with selective PCI, the intraoperative use of low-dose bivalirudin i

关 键 词：冠状动脉疾病 老年人 经皮冠状动脉介入治疗 比伐卢定 

分 类 号：R541.4[医药卫生—心血管疾病]