冠心病患者经皮冠状动脉介入术中使用不同抗凝药物的出血风险差异及对脑微出血数量变化的影响  

Difference of bleeding risk in patients with CHD treated with different anticoagulants during PCI and its influence on number changes of CMBs

作　　者：修明文 边毓尧 饶世俊 何淼 张玉 XIU Mingwen;BIAN Yuyao;RAO Shijun;HE Miao;ZHANG Yu(De-partment of Emergency Medicine,Hebei Petro China Central Hospital,Langfang 065000,China)

机构地区：[1]河北中石油中心医院急诊科,河北廊坊065000

出　　处：《实用医学杂志》2023年第5期631-635,共5页The Journal of Practical Medicine

基　　金：河北省重点研发计划自筹项目(编号:182777143)。

摘　　要：目的 观察冠心病患者经皮冠状动脉介入(PCI)术中使用不同抗凝药物的出血风险差异及对脑微出血(CMBs)数量变化的影响。方法 研究对象为2019年9月至2020年10月河北中石油中心医院急诊科收治的78例PCI患者。根据术中(使用)抗凝药分为肝素组和比伐卢定组,术后72 h行SWI检查,收集术后2周内患者出血部位、出血量,比较两组CMBs、出血事件等指标差异;比较PCI患者二次手术前后CMBs差异;肝素组患者分为出血组和未出血组,分析出血组CMBs变化;采用logistic回归分析影响PCI患者出血的危险因素及对CMBs数量变化的影响。结果 (1)肝素组CMBs数量、出血率高于比伐卢定组,差异有统计学意义(P <0.05)。(2)二次术后CMBs高于术前,差异有统计学意义(P <0.05)。(3)肝素组中出血组肝素量、CMBs高于未出血组,差异有统计学意义(P <0.05)。(4)肝素量、CMBs为影响PCI患者出血的独立危险因素。结论 抗凝药物效果越强、作用靶点越多对CMBs影响越大,CMBs数量对于预测PCI术后出血有临床意义。Objective To observe the difference of bleeding risk in coronary heart disease(CHD)patients using different anticoagulants during percutaneous coronary intervention(PCI)and its influence on the CMBs.Methods Seventy⁃eight patients with PCI admitted to the emergency department of Hebei Petro China Central Hos⁃pital from September 2019 to October 2020 were selected and they were divided into heparin group and bivalirudin group according to the anticoagulants used.Susceptibility weighted imaging(SWI)was performed 72 hours after operation.The bleeding site and volume of patients within 2 weeks after operation were collected,and the differences of CMBs,and bleeding events were compared between the two groups;The CMBs of PCI patients before and after the second operation were compared.The patients in heparin group were divided into two sub⁃groups of bleeding group and non⁃bleeding group,and the changes of CMBs in bleeding group were analyzed.Logistic regression analysis was used to analyze the risk factors of bleeding in PCI patients and the impact on the number changes of CMBs.Results(1)The number of CMBs and bleeding rate in heparin group were significantly higher than those in bivalirudin group(P<0.05).(2)The CMBs after the second operation were higher than those before the second operation,and the difference was statistically significant(P<0.05).(3)Cr,Glu,AA,heparin and CMBs of the bleeding group were higher than those of the non⁃bleeding group(P<0.05).(4)Heparin volume and CMBs were independent risk factors for bleeding in PCI patients.Conclusion The stronger the anticoagulant effect and the more action targets,the greater the impact on CMBs.The number of CMBs is significant for predicting the bleeding after PCI.

关 键 词：经皮冠状动脉介入 磁敏感加权成像 脑微出血 CRUSADE 

分 类 号：R541.4[医药卫生—心血管疾病]