比伐卢定在急性冠脉综合征并慢性肾脏病介入治疗中的疗效分析  

Efficacy and safety of bivalirudin in patients with acute coronary syndrome and chronic kidney disease during PCI

作　　者：付东亮[1] 刘梦茹 肖响 高桐 李春岩[1] 邵明晶[1] 杨鹏[1] 姜红[1] 李宪伦[1] Fu Dongliang;Liu Mengru;Xiao Xiang;Gao Tong;Li Chunyan;Shao Mingjing;Yang Peng;Jiang Hong;Li Xianlun(Cardiology Department of Integrated Traditional Chinese and Western Medicine,China-Japan Friendship Hospital,Beijing 100029,China;Graduate School of Peking Union Medical College,Beijing100730,China)

机构地区：[1]中日友好医院中西医结合心脏内科,北京100029 [2]北京协和医学院研究生院,北京100730

出　　处：《中国医刊》2020年第5期496-500,共5页Chinese Journal of Medicine

摘　　要：目的评价比伐卢定在合并慢性肾脏病的急性冠脉综合征患者介入治疗中的抗凝疗效和安全性。方法选择2016年9月至2019年8月于中日友好医院经皮冠状动脉介入治疗的急性冠脉综合征合并慢性肾脏病患者225例,采用顺序交替法将入选患者分为比伐卢定组(113例)和肝素组(112例)。比较两组间一般情况及经皮冠状动脉介入治疗相关资料,并对两组术后30d出血事件及主要不良心血管事件的发生情况进行统计分析。结果所有患者术后30d内均未发生支架内血栓事件。两组间主要心血管不良事件发生率差异无显著性(P>0.05)。比伐卢定组出血发生率为6.19%,低于肝素组的19.60%,其中轻度出血发生率为4.42%,明显低于肝素组的15.20%,差异均有显著性(P<0.05)。严重出血方面两组差异无显著性(P>0.05)。结论在合并慢性肾脏病的急性冠脉综合征患者经皮冠状动脉介入治疗中应用比伐卢定抗凝治疗安全有效,并可降低出血风险。Objective To evaluate the anticoagulative efficacy and safety of bivalirudin in the interventional treatment of acute coronary syndrome(ACS)patients with chronic kidney disease(CKD).Method A total of 225 patients with ACS and CKD,who received percutaneous coronary intervention(PCI)in China-Japan Friendship Hospital,were continuously enrolled in this study.These patients were divided into 2 groups according to the anticoagulative medication used during PCI:a bivalirudin group(113 cases)and a heparin group(112 cases).The general clinical profile,and PCI-related data,were then compared between the two groups and statistical analyses were carried out with regards to hemorrhage,major adverse cardiovascular events(MACE)occurring within 30 days.Result None of the PCI patients experienced stent thrombosis within 30 days,and there were no statistical differences in the incidence of MACE when compared between the two groups(P>0.05).The bivalirudin group had a significantly reduced rate of hemorrhage(6.19%vs 19.60%,P<0.05),particularly in terms of minor bleeding(4.42%vs 15.20%,P<0.05).There were no statistical differences in terms of severe hemorrhage when compared between the two groups(P>0.05),although the bivalirudin group had a lower risk tendency for severe hemorrhage.Conclusion Bivalirudin is safe and effective during PCI in the anticoagulative treatment of combined CKD with ACS,and reduces the risk of hemorrhage.

关 键 词：比伐卢定 急性冠脉综合征 慢性肾脏病 经皮冠状动脉介入治疗 

分 类 号：R543.3[医药卫生—心血管疾病] R692.5[医药卫生—内科学]