比伐芦定对急性心肌梗死直接经皮冠状动脉介入治疗中冠状动脉血流的影响  

The influence of bivalirudin in coronary blood flow during primary percutaneous coronary intervention for acute myocardial infarction

作　　者：顾崇怀 赵昕[1] 邓宇阳[1] 荆全民[1] 王效增[1] 马颖艳[1] 刘海伟[1] 徐凯[1] 王斌[1] 韩雅玲[1] 

机构地区：[1]沈阳军区总医院心内科,辽宁沈阳110016 [2]安庆市立医院心血管内科

出　　处：《中国介入心脏病学杂志》2017年第11期601-609,共9页Chinese Journal of Interventional Cardiology

基　　金：中国医师协会探索心血管研究基金项目(DFCMDA201417);辽宁省科学技术计划项目(2015020433)

摘　　要：目的评估比伐芦定应用于急性心肌梗死患者行直接经皮冠状动脉介入治疗(PCI)靶血管开通后再灌注血流恢复情况。方法入选2012年5月至2015年4月于沈阳军区总医院接受直接PCI治疗的急性心肌梗死患者245例,依据直接PCI术中用药分为比伐芦定组122例和普通肝素组123例。主要观察指标为冠状动脉造影显示TIMI血栓分级(TIMI thrombus grade)、直接PCI靶血管开通后即刻TIMI(thrombolysis in myocardial infarction)血流、校正TIMI帧数(corrected TIMI frame count,CTFC)及住院期间、出院后30 d、随访1年的净临床不良事件(NACE)、主要不良心血管事件(MACE)及美国出血学术研究联合会出血标准(BARC)出血事件。结果与普通肝素组患者相比,比伐芦定组患者入院平均心率较快[(79.28±15.75)次/min比(75.38±12.75)次/min,P=0.034]。而其他一般资料、实验室指标及介入治疗资料等方面两组间比较,差异均无统计学意义(均P>0.05)。靶血管开通后,无论应用TIMI血流评价系统还是CTFC评价系统,比伐芦定组对于控制直接PCI术中发生慢血流/无复流发生的效果均不劣于普通肝素组(P>0.05)。患者住院期间资料分析显示,比伐芦定组在不增加血小板数目降低风险的基础上能够获得较高的活化凝血时间(ACT)值(P<0.001)。随访30 d及1年结果显示两组MACE、NACE事件发生率比较,差异均无统计学意义(均P>0.05)。结论比伐芦定对急性心肌梗死患者直接PCI治疗具有较好的临床疗效及安全性且不增加直接PCI术中慢血流/无复流发生。Objective To evaluate the efficacy of bivalirudin on reperfusion of coronary artery in patients with acute myocardial infarction undergoing percutaneous coronary intervention. Methods In our study, we evaluated 245 patients with acute myocardial infarction who underwent percutaneous coronary intervention between April 2012 to May 2015. Based on the therapy during operation, bivalirudin were used in 122 patients and heparin was used in 123 patients. Study outcomes included immediate TIMI （thrombolysis in myocardial infarction）flow and CTFC （Corrected TIMI Frame Count）by angiogrophy once the target lesion was opened rates of, in-hospital thrombocytopenia, bleeding events myocardial infarction, repeat revascularization and the incidence of MACE （major adverse cardiac events）in 30 days and 1 year. Results The mean heart rate was higher in the bivalirudin group （P=0.034）. There was no significant difference between the two groups in laboratory results or interventional data （P〉0.05）. After the target vessel was opened, the effect of bivalirudin on slow/no- reflow in primary PCI has no difference between heparin in terms of TIMI blood evaluation or CTFC （P〉0.05）. Hospitalization data analysis showed that bivalirudin was able to obtain a higher activated whole blood coagulation time （ACT）value （P〈0.001）with lower decrease in the number of platelets. Follow-up data of 30 days and 1 year showed no difference in the incidence of MACE and net adverse clinical events （NACE）between the two groups （P〉0.05）. Conclusions Bivalirudin has well efficacy and safety in patients with acute myocardial infarction in patients with acute myocardial infarction undergoing PPCI without increasing the incidence of slow/no-reflow.

关 键 词：比伐芦定 普通肝素 急性心肌梗死 经皮冠状动脉介入治疗 

分 类 号：R541.4[医药卫生—心血管疾病]