比伐卢定对ST段抬高型心肌梗死患者行直接经皮冠状动脉介入治疗的临床观察  

Clinical efficacy of bivalirudin in patients with ST-segment elevation myocardial infarction receiving primary percutaneous coronary intervention

作　　者：刘君[1] 赖俊 何咏聪 张晓雪[1] 陈佳[1] 胡婷婷[1] 叶泽兵[1] Liu Jun;Lai Jun;He Yongcong;Zhang Xiaoxue;Chen Jia;Hu Tingting;Ye Zebing(Department of Cardiology,Guangdong Second Provincial General Hospital,Guangzhou 510317,China)

机构地区：[1]广东省第二人民医院心血管内二科,广州510515

出　　处：《新医学》2020年第3期185-189,共5页Journal of New Medicine

基　　金：广东省医学科学技术研究基金项目(B2019237)。

摘　　要：目的探讨应用比伐卢定对ST段抬高型心肌梗死(STEMI)患者行直接PCI的疗效。方法收集接受急诊PCI治疗的210例STEMI患者临床资料,依据患者用药选择分为比伐卢定组108例和普通肝素组(对照组)102例。PCI中由术者根据患者病情决定是否合并应用替罗非班。分析2组患者PCI前后的临床状况、造影血流情况[心肌梗死溶栓(TIMI)血流分级、TIMI心肌灌注分级]及出血事件。记录住院期间及院外随访30 d内的主要心血管不良事件(MACE)的发生率。结果所有患者的直接PCI均成功。PCI后比伐卢定组TIMIⅢ级血流者比例、TMPⅢ级以上血流者比例及发生无复流现象的比例与对照组比较差异均无统计学意义(P均> 0.05)。2组患者住院期间及院外随访30 d MACE的发生率比较差异均无统计学意义(P均>0.05)。对照组及比伐卢定组各有1例发现重度出血事件,组间比较差异无统计学意义(P> 0.05)。比伐卢定组轻微出血及出血事件总发生率均低于对照组(P <0.05)。结论对于STEMI行直接PCI的患者,使用比伐卢定临床疗效确切,且出血发生率低。Objective To evaluate the clinical efficacy of bivalirudin in patients with ST-segment elevation myocardial infarction(STEMI) undergoing primary percutaneous coronary intervention(PPCI). Methods Clinical data of 210 STEMI patients undergoing emergent PPCI were collected. Based on the therapy during PPCI, 210 STEMI patients were divided into the bivalirudin group(n = 108) and heparin group(control group, n = 102). Whether tirofiban was given or not was determined by the surgeon according to the conditions of patients. Clinical status, coronary artery imaging condition(TIMI blood flow grade and TIMI myocardial perfusion grade) and bleeding events before and after PCI were statistically compared between two groups. The incidence of major adverse cardiac event(MACE) during hospitalization and within 30-d followup was recorded. Results All patients successfully completed PPCI. Following PPCI, the proportion of patients with grade Ⅲ TIMI blood flow, > grade Ⅲ TIMI myocardial perfusion and no-reflow phenomenon did not significantly differ between two groups(all P > 0.05). The incidence of MACE during hospitalization and within 30-d follow-up also did not considerably differ between two groups(both P > 0.05). The incidence of severe bleeding did not significantly differ between control group(n = 1) and bivalirudin group(n = 1)(P > 0.05). The overall incidence of slight bleeding and bleeding in the bivalirudin group was significantly lower compared with that in control group(P < 0.05). Conclusion Application of bivalirudin is an efficacious and safe treatment for STEMI patients undergoing PPCI with a low incidence of bleeding.

关 键 词：心肌梗死 比伐卢定 普通肝素 无复流 经皮冠状动脉介入术 

分 类 号：R542.22[医药卫生—心血管疾病]