比伐芦定用于急性冠状动脉综合征合并慢性肾脏疾病4期患者经皮冠状动脉介入治疗术中抗凝疗效与安全性的评价  

Evaluation of anticoagulant efficacy and safety of bivalirudin in treatment of acute coronary syndrome with stage 4 chronic kidney disease during percutaneous coronary intervention

作　　者：刘少文 兰为群 郑娟娟[1] 胡磊 舒逸[1] 刘如泉[1] 胡家顺 LIU Shao-Wen;LAN Wei-Qun;ZHENG Juan-Juan;HU Lei;SHU Yi;LIU Ru-Quan;HU Jia-Shun(Department of Cardiology,Wuhan Hankou Hospital,Wuhan 430012,China)

机构地区：[1]武汉市汉口医院心血管内科,武汉430012

出　　处：《中华老年多器官疾病杂志》2021年第4期290-294,共5页Chinese Journal of Multiple Organ Diseases in the Elderly

摘　　要：目的评价比伐芦定用于急性冠状动脉综合征(ACS)合并慢性肾脏疾病(CKD)4期患者经皮冠状动脉介入治疗术(PCI)中抗凝疗效与安全性。方法回顾性分析2017年4月至2019年10月在武汉市汉口医院接受PCI治疗的39例ACS合并CKD 2~4期患者的临床资料,根据CKD临床分期标准分为对照组(CKD 2~3期)和观察组(CKD 4期)。比较2组患者围手术期活化凝血时间(ACT),术后24 h活化部分凝血活酶时间(APTT)、凝血酶时间(TT)、凝血酶原时间(PT),术后30 d出血情况及主要不良心脑血管事件(MACCE)。采用SPSS 20.0统计软件对数据进行分析。组间比较采用t检验或χ~2检验。结果对照组和观察组给药后10 min ACT值[(438.38±76.79)和(413.61±66.49)s]、术后即刻ACT值[(457.38±73.13)和(425.28±60.96)s]及停药后2 h ACT值[(184.21±48.15)和(171.39±38.86)s]比较,差异均无统计学意义(均P>0.05)。对照组和观察组术后24 h APTT[(37.67±5.51)和(39.50±9.04)s]、TT[(37.52±8.21)和(38.44±7.04)s]及PT[(14.76±3.13)和(15.00±3.01)s]比较,差异均无统计学意义(均P>0.05)。30 d随访结果显示,对照组和观察组出血学术研究会(BARC)1型出血事件发生率[14.29%(3/21)和11.11%(2/18)]及BARC 2型出血事件发生率[4.76%(1/21)和5.56%(1/18)]比较,差异均无统计学意义(均P>0.05),均未发生BRAC 3~5型出血事件。对照组和观察组MACCE发生率[9.52%(2/21)和11.11%(2/18)]比较,差异无统计学意义(P>0.05)。结论比伐芦定用于ACS合并CKD4期患者PCI术中抗凝具有较好的疗效及安全性。Objective To evaluate the anticoagulant efficacy and safety of bivalirudin in patients with acute coronary syndrome(ACS)and stage 4 chronic kidney disease(CKD)during percutaneous coronary intervention(PCI).Methods A retrospective analysis was made of the clinical data of 39 ACS patients with CKD stages 2 to 4 who underwent PCI in Hankou Hospital of Wuhan from April 2017 to October 2019.The patients were divided into control group(CKD stages 2 to 3)and observation group(CKD stage 4)according to the CKD clinical staging criteria.The two groups were compared for the activated clotting time(ACT)in the perioperative period,activated partial thromboplastin time(APTT),thrombin time(TT)and prothrombin time(PT)at 24 h after operation,bleeding at 30 d after operation,and major adverse cardiac and cerebrovascular events(MACCE).Data were analyzed using SPSS statistics 20.0.Comparisons between groups were performed using t tests orχ~2 tests.Results There were no significant differences between the control and observation groups in ACT at 10 min after drug administration[(438.38±76.79)vs(413.61±66.49)s],at immediate postoperative period[(457.38±73.13)vs(425.28±60.96)s],and at 2 h after drug withdrawal[(184.21±48.15)vs(171.39±38.86)s](P>0.05 for all).Control and observation groups did not have significant differences in APTT[(37.67±5.51)vs(39.50±9.04)s],TT[(37.52±8.21)vs(38.44±7.04)s],and PT[(14.76±3.13)vs(15.00±3.01)s]at 24 h postoperatively(P>0.05 for all).At 30-d follow-up,there was no significant difference between control and observation groups in the incidence of BARC type 1 bleeding events[14.29%(3/21)vs 11.11%(2/18)]and BARC type 2 bleeding events[4.76%(1/21)vs 5.56%(1/18)](P>0.05 for both),and no patients had a BARC type 3 to 5 bleeding event.There was no significant difference between the two groups in the incidence of MACCE[9.52%(2/21)vs 11.11%(2/18)](P>0.05).Conclusion Bivalirudin had good efficacy and safety in anticoagulation in patients with ACS and CKD4 during PCI.

关 键 词：急性冠脉综合征 慢性肾脏疾病 比伐芦定 

分 类 号：R541[医药卫生—心血管疾病]