肝素与比伐芦定对女性冠心病患者经皮冠状动脉介入治疗影响比较  

Comparison of the effects of heparin and Bivalirudin on percutaneous coronary intervention in female patients with coronary heart disease

作　　者：陈三保 李毅 裘淼涵 蒋再新 韩雅玲 李晶 CHEN San-bao;LI Yi;QIU Miao-han;JIANG Zai-xin;HAN Ya-ling;LI Jing(Department of Cardiology,General Hospital of Northern Theater Command,Shenyang 110016,China;The Second Clinical College of Dalian Medical University,Dalian 116000,Liaoning,China)

机构地区：[1]北部战区总医院心血管内科,辽宁沈阳110016 [2]大连医科大学第二临床学院,辽宁大连116000

出　　处：《临床军医杂志》2021年第3期246-250,253,共6页Clinical Journal of Medical Officers

基　　金：立信扬帆优化抗栓研究基金(BJUHFCSOARF201801-07);国家重点研发计划(2016YFC1301303)。

摘　　要：目的比较真实世界中肝素与比伐芦定对女性冠心病患者经皮冠状动脉介入治疗(PCI)的影响。方法将北部战区总医院自2016年1月至2018年11月收治的接受PCI的女性冠心病患者3421例纳入研究。根据抗凝治疗方案不同,将患者分为肝素组(n=2599)和比伐芦定组(n=822)。肝素组:PCI术前静脉推注负荷剂量80~100 U/kg;首次给药5 min后监测活化凝血时间(ACT),若ACT<200 s,追加肝素20 U/kg静脉推注。比伐芦定组:PCI术前静脉推注负荷剂量0.75 mg/kg,然后以1.75 mg/(kg·h)的速度持续泵注至手术结束,术后维持此剂量至少30 min;首次给药5 min后监测ACT,若ACT<225 s,追加比伐芦定0.30 mg/kg静脉推注。采用倾向性评分法按1:2的比例对两组患者进行匹配。比较两组患者的临床基线和手术资料,以及术后30 d内终点事件的发生情况。结果倾向性匹配前:与肝素组比较,比伐芦定组患者年龄更大,既往卒中比例、右冠状动脉病变比例、CRUSADE评分更高,而血小板计数、血红蛋白水平、内生肌酐清除率、桡动脉入路比例、吸烟比例均更低,差异有统计学意义(P<0.05)。倾向性匹配后:与肝素组比较,比伐芦定组患者CRUSADE评分更高,而血红蛋白水平更低,差异有统计学意义(P<0.05)。倾向性匹配前:与肝素组比较,比伐芦定组患者净不良临床事件和全部出血的发生率均更低,差异有统计学意义(P<0.05)。倾向性匹配后:与肝素组比较,比伐芦定组患者净不良临床事件和主要心脑血管不良事件均更低,差异有统计学意义(P<0.05)。结论与肝素比较,比伐芦定可显著降低女性冠心病患者PCI术后30 d内的净不良临床事件和主要心脑血管不良事件的发生风险。Objective To compare the effects of heparin and Bivalirudin on percutaneous coronary intervention(PCI)in female with coronary heart disease in the real world.Methods A retrospective study was performed on 3421 female patients with coronary heart disease receiving PCI admitted from January 2016 to November 2018.Patients were divided into the heparin group(n=2599)and Bivalirudin group(n=822)according to different anticoagulant therapy regimens.Heparin group:loading dose of 80-100 U/kg was injected intravenously before PCI;activated coagulation time(ACT)was monitored 5 minutes after the first administration,and 20 U/kg heparin was added intravenously if ACT<200 s.Bivalirudin group:the loading dose of 0.75 mg/kg was intravenously injected before PCI,and then the loading dose was continuously pumped at the rate of 1.75 mg/(kg·h)until the end of operation,and the dose was maintained for at least 30 minutes after PCI;ACT was monitored 5 minutes after the first administration,and if ACT<225 s,0.30 mg/kg of Bivalirudin was added intravenously.Clinical baseline and surgical data,as well as the incidence of end points within 30 days after surgery were compared between the two groups.Two groups of patients were matched by propensity score at a ratio of 1:2.Results Before the tendency matching:compared with heparin group,the age of patients in Bivalirudin group was higher,the proportion of previous stroke,the proportion of right coronary artery disease and CRUSAD score were higher,while platelet count,hemoglobin level,endogenous creatinine clearance rate,radial artery access ratio and smoking ratio were lower,the difference was statistically significant(P<0.05).After propensity matching:compared with heparin group,CRUSAD score was higher and hemoglobin level was lower in Bivalirudin group(P<0.05).Before propensity matching,compared with the heparin group,the incidence of net adverse clinical events and total bleeding in the Bivalirudin group was lower(P<0.05).After propensity matching:compared with heparin group,the net adve

关 键 词：肝素 比伐芦定 女性 冠心病 经皮冠状动脉介入治疗 

分 类 号：R541.4[医药卫生—心血管疾病]