经皮冠状动脉介入治疗联合比伐卢定治疗急性心肌梗死患者对心肌梗死溶栓治疗心肌灌注分级及主要心血管不良事件的影响  

The effect of percutaneous coronary intervention combined with bivalirudin on thrombolysis in myocardial infarction myocardial perfusion grade and major adverse cardiovascular events in patients with acute myocardial infarction

作　　者：王汝意 李芹[2] 何新泽 曹俊强[1] 赵习玲[1] Wang Ruyi;Li Qin;He Xinze;Cao Junqiang;Zhao Xiling(Department of Cardiovascular Internal Medicine Second Ward,Binzhou Central Hospital,Binzhou 251700,China;Department of Emergency,Binzhou Central Hospital,Binzhou 251700,China)

机构地区：[1]滨州市中心医院心血管内科二病区,山东滨州251700 [2]滨州市中心医院急诊科,山东滨州251700

出　　处：《中国临床实用医学》2021年第5期34-37,共4页China Clinical Practical Medicine

摘　　要：目的探究与分析经皮冠状动脉介入治疗(PCI)联合比伐卢定治疗急性心肌梗死患者对心肌梗死溶栓治疗(TIMI)心肌灌注分级(TMPG)及主要心血管不良事件(MACE)的影响。方法选取2018年4月至2021年4月滨州市中心医院心血管内科二病区收治的经PCI治疗的108例心肌梗死患者,男57例,女51例,年龄(62.15±2.43)岁,年龄范围为55~69岁。根据治疗方法不同分为肝素组(n=58)与比伐卢定组(n=50),肝素组在术中给予注射肝素钠注射液,比伐卢定组采用注射用比伐卢定。比较两组患者PCI术后24 h、术后3个月的心功能指标[左心室射血分数(LVEF)、左心室舒张末期内径(LVEDD)及室间隔厚度(IVSD)]、ST段回落率、TMPG 3级率、术后30 d内的MACE率。结果比伐卢定组PCI术后3个月LVEF[(43.51±4.74)%]低于肝素组[(46.30±5.82)%],差异有统计学意义(P<0.05),LVEDD[(48.43±5.60)mm]及IVSD[(10.89±2.11)mm]与肝素组[(49.11±6.24)mm、(10.95±2.02)mm]比较,差异无统计学意义(P>0.05)。比伐卢定组ST段回落率[82.0%(41/50)]、TMPG 3级率[86.0%(43/50)]均高于肝素组[46.6%(27/58)、51.7%(30/58)],差异有统计学意义(P<0.001)。比伐卢定组患者术后30 d内MACE发生率[6.0%(3/50)]低于肝素组[19.0%(11/58)],差异有统计学意义(P<0.05)。结论PCI联合比伐卢定治疗急性心肌梗死患者可明显改善患者的心功能,降低出血及冠状动脉内血栓发生风险,促进改善心肌组织灌注,同时也避免增加了MACE发生率。Objective To investigate and analyze the effects of percutaneous coronary intervention(PCI)combined with Bivalirudin on acute myocardial infarction patients thrombolysis in myocardial infarction(TIMI)myocardial perfusion grade(TMPG)and major adverse cardiovascular events(MACE)in patients.Methods From April 2018 to April 2021,108 patients with myocardial infarction treated by PCI in the second ward of the department of Cardiovascular Medicine of Binzhou Central Hospital were selected,57 males and 51 females,aged(62.15±2.43)years old,range is 55 to 69 years old.According to different treatment methods,they were divided into heparin group(n=58)and bivalirudin group(n=50).The heparin group was given heparin sodium injection during surgery,and the bivalirudin group was given bivalirudin for injection.Left ventricular ejection fraction(LVEF),left ventricular end diastolic diameter(LVEDD),interventricular septal thickness(IVSD),ST segment regression rate,TMPG grade 3 rate and MACE rate within 30 days after PCI were compared between the two groups.Results The LVEF[(43.51±4.74)%]of the bivalirudin group was lower than that of the heparin group[(46.30±5.82)%]at 3 months after PCI,the difference was statistically significant(P<0.05),LVEDD[(48.43±5.60)mm]and IVSD[(10.89±2.11)mm]compared with the heparin group[(49.11±6.24)mm,(10.95±2.02)mm],the difference was not statistically significant(P>0.05).The ST segment fall rate[82.0%(41/50)]and TMPG grade 3 rate[86.0%(43/50)]in the bivalirudin group were higher than those in the heparin group[46.6%(27/58),51.7%(30/58)],the difference was statistically significant(P<0.001).The MACE rate of patients in the bivalirudin group[6.0%(3/50)]within 30 days after surgery was lower than that of the heparin group[19.0%(11/58)],the difference was statistically significant(P<0.05).Conclusion PCI combined with bivalirudin in the treatment of patients with acute myocardial infarction can significantly improve the patient′s heart function,reduce the risk of bleeding and coronary thrombosis,

关 键 词：经皮冠状动脉介入治疗 比伐卢定 急性心肌梗死 心肌梗死溶栓治疗 主要心血管不良事件 

分 类 号：R542.22[医药卫生—心血管疾病]