比伐芦定对老年急性冠脉综合征患者介入治疗术后心肌微循环及不良事件的影响  

Influence of bivalirudin on myocardial microcirculation and adverse events after percutaneous coronary intervention in elderly patients with acute coronary syndrome

作　　者：纪军[1] 何胜虎[1] 陈述[1] 徐日新[1] 刘晓东[1] 徐冰[1] 张建秋[1] JI Jun;HEShenghu;CHEN Shu;XU Rixin;LIU Xiaodong;XU Bing;ZHANG Jianqiu(Department of Cardiology,Subei People＇s Hospital in Jiangsu Province,Yangzhou,Jiangsu,225001)

机构地区：[1]江苏省苏北人民医院心内科,江苏扬州225001

出　　处：《实用临床医药杂志》2018年第17期11-14,共4页Journal of Clinical Medicine in Practice

摘　　要：目的探讨比伐芦定对老年急性冠脉综合征患者介入治疗术后即刻心肌微循环及随访6个月主要心脏不良事件(MACE)的影响。方法选取120例资料完整的急性冠脉综合征老年患者,均行介入治疗,随机分为比伐芦定组和普通肝素组各60例。随访6个月,比较2组患者介入治疗术中活化凝血时间(ACT)达标率及即刻发生慢血流或无复流的情况,住院期间和随访期间发生心绞痛、靶血管再次血运重建率、非致死性心肌梗死、心力衰竭、心源性死亡等主要心血管不良事件以及出血的发生情况。结果比伐芦定组术中ACT达标率显著高于普通肝素组(P<0.05)。比伐芦定组术后即刻TIMI心肌灌注分级(TMP)、校正的TIMI血流帧数计数(CTFC)显著优于普通肝素组(P<0.05)。住院及随访期间,比伐芦定组出血情况显著优于普通肝素组(P<0.05),总MACE发生率显著低于普通肝素组(P<0.05)。结论对于老年急性冠脉综合征行介入治疗的患者,使用比伐芦定可以获得更高的ACT达标率,更好的心肌微循环再灌注,还可减少出血及心脏不良事件的发生率。Objective To explore influence of bivalirudin on myocardial microcirculation at immediate time of operative completion and major adverse cardiac events（ MACE） after 6-month follow up during percutaneous coronary intervention in elderly patients with acute coronary syndrome.Methods A total of 120 elderly acute coronary syndrome patients with integrate data who underwent interventional treatment were divided into bivalirudin group（ 60 cases） and heparin group（ 60 cases）.After 6-month follow-up,the standard-reaching rate of activate clotting time（ ACT） during operation,slow or non reflow condition at immediate time of opertion were compared between the two groups.MACE,including angina pectoris,target vessel revascularization rate,nonfatal myocardial infarction,heart failure,cardiogenic death and the occurrence of blooding during hospital stay and follow-up were observed. Results The bivalirudin group had higher ACT during operation,and significantly better TIMI myocardial perfusion grade（ TMP） and corrected TIMI frame count（ CTFC） than heparin group（ P〈0. 05）. The bleeding condition during hospital stay and follow-up in the bivalirudin group was lower,and the incidence of MACE in bivalirudin group was significantly less than that of heparin group（ P〈0. 05）. Conclusion Bivalirudin can obtain higher standard-reaching rate of ACT,and myocardial microcirculation perfusion,and it can decrease risk of bleeding,as well as adverse cardiac events in elderly patients with acute coronary syndrome.

关 键 词：比伐芦定 肝素 急性冠脉综合征 校正的TIMI血流帧数计数 TIMI心肌灌注分级 

分 类 号：R541.4[医药卫生—心血管疾病]