比伐芦定与肝素在非ST段抬高急性冠脉综合征患者PCI术中的疗效对比  

Comparison in Curative Effect Between Bivalirudin and Heparin in PCI for Patients with Non-ST-Segment Elevation Acute Coronary Syndrome

作　　者：王晓娜 潘亮[1] 李然[1] 王徐乐[1] 邱春光[1] 孙国举[1] WANG Xiao-na;PAN Liang;LI Ran;WANG Xu-le;QIU Chun-guang;SUN Guo-ju(Department of Cardiology,the First Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China)

机构地区：[1]郑州大学第一附属医院心血管内科,河南郑州450052

出　　处：《河南医学研究》2020年第9期1556-1559,共4页Henan Medical Research

基　　金：河南省高等学校重点科研项目计划(19A320084)。

摘　　要：目的比较比伐芦定与肝素应用于非ST段抬高急性冠脉综合征(NSTE-ACS)患者经皮冠状动脉介入(PCI)术中的效果。方法连续纳入2018年6月至2019年8月于郑州大学第一附属医院诊断为NSTE-ACS并行PCI治疗的500例患者,其中比伐芦定组(50例)和采用1∶1倾向评分匹配法筛选出肝素组(50例),比较两组患者术前、用药后5 min、用药后30 min、术后即刻、停药后1 h、停药后2 h的活化凝血时间(ACT),并观察两组患者30 d内出血及主要心脑血管不良事件(MACCE)的发生情况。结果两组患者在用药后5 min ACT均>250 s。PCI术前两组患者ACT比较,差异无统计学意义(P>0.05)。用药后5 min、用药后30 min、术后即刻比伐芦定组ACT高于肝素组,差异有统计学意义(P<0.05)。停药后1、2 h比伐芦定组ACT低于肝素组,差异有统计学意义(P<0.05)。术后30 d随访,两组患者出血事件及MACCE发生率比较,差异无统计学意义(P>0.05)。结论与肝素相比,比伐芦定应用于NSTE-ACS行PCI术的患者,术中抗凝稳定性更好,术后短期内并没有增加出血及MACCE事件发生。Objective To compare the efficacy between bivalirudin and heparin in the percutaneous coronary intervention(PCI)for patients with non-ST-segment elevation acute coronary syndrome(NSTE-ACS).Methods Five hundreds NSTE-ACS patients undergone PCI in the First Affiliated Hospital of Zhengzhou University from June 2018 to August 2019 were enrolled in the study,including bivaludin group(50 cases)and heparin group(50 cases)which were screened by a 1∶1 propensity score matching method.The activated coagulation time(ACT)were compared between the two groups before PCI,5 minutes after medication,30 minutes after medication,immediately after PCI,1 and 2 hours after drug withdrawal.The incidence of hemorrhage and major adverse cardiovascular and cerebrovascular events(MACCE)were observed in the two groups within 30 days after PCI.Results The ACT of the two groups were>250 s 5 minutes after medication.There was no significant difference in ACT between the two groups before PCI(P>0.05).Compared with heparin group,the ACT of bivalrudin group were higher during 5 minutes after medication,30 minutes after medication,immediately after PCI,and lower 1 and 2 hours after drug withdrawal,and the differences were statistically significant(P<0.05).There were no significant differences in the incidence of hemorrhage and MACCE between the two groups during 30 days’follow-up(P>0.05).Conclusion Compared with heparin,bivalirudin is more effective stable in anticoagulation for NSTE-ACS patients undergoing PCI.There is no increase in hemorrhage and MACCEs in the short term after PCI.

关 键 词：非ST段抬高急性冠脉综合征 经皮冠状动脉介入 比伐芦定 肝素 

分 类 号：R541.4[医药卫生—心血管疾病]