比伐卢定在急性冠脉综合征中高危出血风险患者PCI介入治疗中的疗效和安全性研究  

Study on the efficacy and safety of bivalirudin in PCI for patients with acute coronary syndrome at high risk of bleeding

作　　者：王志勇 李纲 张丽琨 

机构地区：[1]北京燕化医院心内科,北京100025

出　　处：《中国循证心血管医学杂志》2017年第9期1034-1036,共3页Chinese Journal of Evidence-Based Cardiovascular Medicine

基　　金：国家自然科学基金(81100143)

摘　　要：目的比较比伐卢定与替罗非班联合依诺肝素在急性冠脉综合征(ACS)中高危出血风险患者经皮冠状动脉介入治疗(PCI)中的疗效和安全性。方法选取2015年10月~2016年9月于北京燕化医院心内科住院治疗的ACS并行PCI治疗的患者,按照CRUSADE出血风险分级分为试验组和对照组,试验组在PCI术中给予比伐卢定,对照组在术前给予依诺肝素+术中给予替罗非班,分别观察两组患者在术后冠状动脉犯罪血管TIMI血流分级及PCI术后30 d内心脏不良事件的发生率和出血情况。结果试验组在性别、糖尿病史、外周血管病史、心力衰竭发病率方面明显高于对照组,差异有统计学意义(P<0.05);两组患者PCI术后犯罪血管TIMI血流分级比较,差异无统计学意义(P>0.05);两组患者PCI术后30 d内心脏不良事件发生率比较,差异无统计学意义(P>0.05);两组患者PCI术后30 d内出血发生率比较,试验组有1例(2.12%)出血事件,对照组有6例(10.34%)出血事件,差异有统计学意义(P<0.05)。结论比伐卢定和替罗非班联合依诺肝素在预防ACS患者PCI术后30 d内心脏不良事件方面疗效相当,但比伐卢定可明显降低ACS中高危患者PCI术后出血的发生率。Objective To compare efficacy and safety of bivalirudin and tirofiban combined with enoxaparin in percutaneous coronary intervention （PCI） for patients with acute coronary syndrome （ACS） at high risk of bleeding. Methods The ACS patients who received PCI were selected from Oct. 2015 to Sep. 2016. They were divided into experimental group and control group according to CRUSADE bleeding risk classification. The experimental group was given bivalirudin after PCI operation. The control group was given enoxaparin before PCI operation and given tirofiban after PCI operation. Postoperative coronary artery vasospasm blood stream grade and the incidence of adverse cardiac events and bleeding of the two groups of patients undergoing PCI after 30 days are evaluated respectively. Results Gender, the history of diabetes, peripheral vascular and heart failure in experimental group ware significantly higher than those in control group （P〈0.05）. no significant difference between the two groups with respect to TIMI classification （P〉0.05）. There was no significant difference in the incidence of adverse cardiac events between the two groups （P〉0.05）. There were 1 （2.12%） bleeding events in experimental group and 6 （10.34%） bleeding in control group. There was a significant difference in the incidence of bleeding between the two groups （P〈0.05）. Conclusion Bivalirudin and tirofiban combined with enoxaparin show similar efficacy in prevention of the postoperative incidence of adverse cardiac events after 30 days of PCI. But, bivalirudin can effectively reduce the incidence of postoperative bleeding after PCI.

关 键 词：急性冠脉综合征 PCI 比伐卢定 替罗非班 依诺肝素 

分 类 号：R541.4[医药卫生—心血管疾病]