比伐芦定联合重组人尿激酶原对老年急性心肌梗死患者直接PCI术后慢血流/无复流的影响及安全性  

Effect and safety of bivalrudine combined with recombinant human prourokinase on slow/no-reflow after emergency PCI in elderly patients with acute myocardial infarction

作　　者：白文楼 陈涛[2] 孟存良[1] 高曼 陈学锋[1] 姚文静[1] BAI Wenlou;CHEN Tao;MENG Cunliang;GAO Man;CHEN Xuefeng;YAO Wenjing(Cardiac Center, Hebei Provincial People's Hospital, Shijiazhuang, 050051,China;Department of Cardiology, Third Hospital of Hebei Medical University)

机构地区：[1]河北省人民医院心脏中心,石家庄050051 [2]河北医科大学第三医院心内科

出　　处：《临床心血管病杂志》2019年第7期595-599,共5页Journal of Clinical Cardiology

摘　　要：目的:探讨比伐芦定联合重组人尿激酶原对老年急性ST段抬高型心肌梗死(ST-segment elevation myocardial infarction,STEMI)患者直接冠状动脉介入术(percutaneous coronary intervention,PCI)后慢血流/无复流的影响及安全性。方法:回顾性分析2015-01-2018-11于河北省人民医院心脏中心与河北医科大学第三医院心内科行直接PCI治疗的年龄≥60岁的老年高血栓负荷STEMI患者178例。根据治疗方法的不同,将所纳入患者分为4组:普通肝素组51例(A组),普通肝素+重组人尿激酶原组42例(B组),比伐芦定组(C组)45例,比伐芦定+重组人尿激酶原组40例(D组)。观察4组患者直接PCI术后TIMI血流分级、校正帧幅数(corrected TIMI frame count,cTFC)、TIMI心肌灌注分级(TIMI myocardial perfusion grade,TMPG)、术后2hST段回落率(ST-segment resolution,STR),术后1个月内出血情况及主要心脏不良事件(major adverse cardiacevents,MACEs)发生率。结果:B组和D组慢血流/无复流(TIMI≤2级)的发生率和cTFC均低于A组和C组,达到TMPG 3级比例和STR比例均高于A组和C组,均差异有统计学意义(均P<0.05)。4组患者直接PCI后1个月内再发心肌梗死、恶性心律失常、充血性心力衰竭和死亡发生率之间无统计学差异。C组和D组出血发生率低于A组和B组,但差异无统计学意义。结论:比伐芦定联合重组人尿激酶原可以有效改善心肌灌注水平,减少慢血流/无复流的发生率,而且相比肝素出血风险更低,适合应用于老年高血栓负荷心肌梗死患者。Objective:To investigate the effect and safety of bivalirudine combined with recombinant human prourokinase on slow/no-reflow after primary percutaneous coronary intervention(PCI)in elderly patients with acute ST-segment elevation myocardial infarction(STEMI).Method:A retrospective analysis was made in 178 elderly STEMI patients aged over 60 who received primary PCI from January 2015 to November 2018 in the Heart Center of Hebei Provincial People’s Hospital and the Third Hospital of Hebei Medical University.According to treatment methods,all subjects were divided into four groups:51 cases in the heparin group(group A),42 cases in the heparin+recombinant human prourokinase group(group B),45 cases in the bivalirudine group(group C)and40 cases in the bivalirudine+ recombinant human prourokinase group(group D).TIMI blood flow grading,corrected TIMI frame count(cTFC),TIMI myocardial perfusion grading(TMPG),ST-segment resolution(STR)2 hours after primary PCI,bleeding within 1 month and incidence of major adverse cardiac events(MACEs)were observed.Result:The incidence of slow blood flow/no-reflow(TIMI≤grade 2)and cTFC in group B and group D were statistically lower than those in group A and group C,the proportion of TMPG 3 and STR were statistically higher than those in group A and group C(all P<0.05).There was no significant difference in MACEs,includingrecurrent myocardial infarction,malignant arrhythmia,congestive heart failure and death within 1 month after primary PCI between the four groups.The incidence of bleeding in group A and group B were lower than those in group Band group D,but there was no statistical difference.Conclusion:Bivalrudin combined with recombinant human prourokinase can effectively improve myocardial perfusion level and reduce the incidence of slow/no-reflow,and has lower risk of hemorrhage than heparin.It is suitable for elderly patients with high thrombotic load myocardial infarction.

关 键 词：急性心肌梗死 经皮冠状动脉介入术 比伐芦定 重组人尿激酶原 慢血流/无复流 

分 类 号：R542.22[医药卫生—心血管疾病]