减量比伐卢定在高危出血风险冠心病患者择期行经皮冠状动脉介入治疗中的应用研究  

Application of reduced-dose bevacrolidine in elective percutaneous coronary intervention in patients with coronary heart disease at high risk of bleeding

作　　者：邓俊国[1] 孟令秀 熊爱红 王雪梅[2] 王龙[3] DENG Jun-guo;MENG Ling-xiu;XIONG Ai-hong;WANG Xue-mei;WANG Long(Department of Cardiology I,the Second Hospital of Qinhuangdao,Qinhuangdao 066600,Hebei;Department of Infectious Diseases,the Second Hospital of Qinhuangdao,Qinhuangdao 066600,Hebei;Department of Electrophysiology,Peking University People s Hospital,Beijing 100044,China)

机构地区：[1]秦皇岛市第二医院心内一科,河北秦皇岛066600 [2]秦皇岛市第二医院感染科,河北秦皇岛066600 [3]北京大学人民医院心电生理室,北京100044

出　　处：《川北医学院学报》2022年第10期1317-1320,共4页Journal of North Sichuan Medical College

基　　金：河北省秦皇岛市重点研发计划科技支撑项目(201805A018)。

摘　　要：目的:探讨减量比伐卢定在高危出血风险冠心病患者择期行经皮冠状动脉介入治疗(PCI)中的疗效及安全性。方法:选取140例择期行PCI的高危出血风险冠心病患者为研究对象,按照给药剂量不同分为低剂量组和常规剂量组,每组各70例。所有患者PCI术中均给予比伐卢定抗凝,首次给药剂量为0.75 mg/kg静脉推注,之后常规剂量组与低剂量组分别以1.75 mg·kg^(-1)·h^(-1)、1.5 mg·kg^(-1)·h^(-1)比伐卢定持续静脉滴注至PCI结束,并根据活化凝血时间(ACT)调整剂量维持至术后4 h。比较两组患者围术期活化凝血时间(ACT)、心梗溶栓实验(TIMI)血流分级、心肌损伤[心肌肌钙蛋白I(cTnI)及肌酸激酶同工酶MB(CK-MB)]情况、术后3个月主要心血管不良事件(MACE)及出血事件发生率。结果:给药后5 min,两组患者ACT比较,差异无统计学意义(P>0.05);给药后30 min、手术结束时、术后1、4 h,低剂量组ACT低于常规剂量组(P<0.05)。与PCI术前相比,术后两组患者TIMI血流分级均改善(P<0.05),但组间比较差异无统计学意义(P>0.05)。术后24 h,两组患者血清cTnI、CK-MB水平比较,差异无统计学意义(P>0.05)。术后30 d,低剂量组MACE发生率与常规剂量组比较,差异无统计学意义(P>0.05);出血事件发生率低于常规剂量组(P<0.05)。结论:高危出血风险冠心病患者择期PCI术中,减量与常规剂量比伐卢定抗凝均能有效改善患者TIMI血流分级,但减量比伐卢定能够减低术后出血风险,提高安全性。Objective:To investigate the efficacy and safety of reduced-dose bevacrolidine in percutaneous coronary intervention(PCI)for patients with coronary heart disease at high risk of bleeding.Methods:A total of 140 patients with coronary heart disease at high risk of bleeding undergoing PCI were selected and divided into low-dose group and conventional dose group according to the dosage,with 70 cases in each group.All patients were given anticoagulation by rupee method during PCI,and the first dose was 0.75 mg/kg intravenous injection.After that,the conventional dose group and the low dose group were continuously intravenous dripped with 1.75 mg·kg^(-1)·h^(-1)and 1.5 mg·kg^(-1)·h^(-1)bevacrolidine until the end of PCI,and the dose was adjusted according to the active clotting time(ACT)to maintain until 4 h after operation.The perioperative ACT value,thrombolysis in myocardial infarction(TIMI)blood flow grade,myocardial injury[cardiac troponin I(cTnI)creatine kinase MB(CK-MB)]and the incidence of major adverse cardiovascular events(MACE)and bleeding events at 3 months after operation were compared between the two groups.Results:At 5 min after administration,there was no significant difference in ACT between the two groups(P>0.05).At 30 min after administration,the end of operation,1 h and 4 h after operation,the ACT value of the low dose group was lower than that of the conventional dose group(P<0.05).Compared with before PCI,the TIMI blood flow grade in the two groups was significantly improved after PCI(P<0.05),but there was no difference between the two groups(P>0.05).At 24 h after operation,there was no significant difference in serum cTnI and CK-MB levels between the two groups(P>0.05).At 30 days after operation,there was no significant difference in the incidence of MACE between the two groups(P>0.05),and the incidence of bleeding events in low-dose group was lower than that in the conventional dose group(P<0.05).Conclusion:Reduced dose and conventional dose of bivalirudin can effectively improve TIMI blood f

关 键 词：冠心病 高位出血风险 比伐卢定 抗凝 主要心血管不良事件 出血事件 

分 类 号：R452[医药卫生—治疗学]