比伐卢定对溶栓失败AMI的应用价值研究  

Application value of bivalirudin in treatment for acute myocardial infarction with thrombolytic failure

作　　者：侯曼利 闫杰 罗佩佩 王阳阳 HOU Manli;YAN Jie;LUO Peipei;WANG Yangyang(Internal Department 1,Huanghe S&T College Affiliated Hospital,Zhengzhou,Henan 450000,China;Emergency Department,Huanghe S&T College Affiliated Hospital,Zhengzhou,Henan 450000,China;Academic Affairs Office,Henan Health Cadre College,Zhengzhou,Henan 450000,China;Department of Cardiovascular Medicine,Pingdingshan the Second People's Hospital,Pingdingshan,Henan 467000,China)

机构地区：[1]黄河科技学院附属医院内一科,河南郑州450000 [2]黄河科技学院附属医院急诊科,河南郑州450000 [3]河南卫生健康干部学院教务处,河南郑州450000 [4]平顶山市第二人民医院心血管内科,河南平顶山467000

出　　处：《中国医学工程》2025年第4期68-72,共5页China Medical Engineering

基　　金：河南省医学科技攻关项目(LHGJ2020021837)。

摘　　要：目的观察比伐卢定对溶栓失败急性心肌梗死(AMI)患者的应用价值。方法纳入河南黄河科技学院附属医院2021年5月至2023年5月收治的112例AMI患者作为研究对象,开展前瞻性、随机对照试验。采用电脑随机分组法将入组患者分别列为肝素组和比伐卢定组各56例,两组溶栓失败后均实施经皮冠脉介入术(PCI)进行挽救性治疗,肝素组采用肝素辅助治疗,比伐卢定组采用比伐卢定辅助治疗,比较两组患者的心肌灌注情况,心肌损伤标志物水平变化情况,心功能恢复情况,及预后情况。结果比伐卢定组的心肌梗死溶栓治疗实验(TIMI)分级3级、TIMI心肌灌注分级(TMPG)3级占比分别为85.71%(48/56)、91.07%(51/56),均高于肝素组[62.50%(35/56)、67.86%(38/56)](P<0.05);比伐卢定组的校正TIMI血流帧数计数(cTFC)为(30.23±5.24),低于肝素组(33.46±5.33)(P<0.05),心肌灌注指数(PI)为(55.62±10.44)%,高于肝素组[(50.35±10.21)%](P<0.05);比伐卢定组的肌红蛋白(MYO)、肌酸激酶同工酶(CK-MB)、乳酸脱氢酶(LDH)分别为(61.23±10.41)μg/L、(10.25±2.31)U/L、(40.22±10.25)U/L,均低于肝素组[(66.43±10.28)μg/L、(12.41±3.25)U/L、(45.62±10.31)U/L](P<0.05);比伐卢定组的左心室射血分数(LVEF)为(55.18±10.29)%,高于肝素组[(50.31±10.24)%](P<0.05),左心室舒张末期容积(LVEDV)、左心室收缩末期容积(LVESV)分别为(115.32±20.33)mL、(55.27±10.25)mL,均低于肝素组[(130.25±20.32)mL、(60.41±10.28)mL](P<0.05);比伐卢定组的不良预后发生率为5.36%(3/56),低于肝素组[21.43%(12/56)](P<0.05)。结论比伐卢定能帮助AMI患者恢复心肌血流灌注,将此药用于挽救性PCI围手术期抗凝能减轻患者心肌损伤、改善心功能,对改善患者预后也有重要意义。【Objective】To observe the application value of bivalirudin in acute myocardial infarction(AMI)patients who have failed thrombolysis.【Methods】This study was a prospective study,in which 112 AMI patients admitted to Huanghe S&T College Affiliated Hospital from May 2021 to May 2023 were randomly selected.The enrolled patients were randomly divided into the heparin group(56 cases)and the bivalirudin group(56 cases)using computer randomization method.After thrombolysis failure,both groups received percutaneous coronary intervention(PCI)for salvage treatment.The heparin group received heparin adjuvant treatment,while the bivalirudin group received bivalirudin adjuvant treatment.The myocardial perfusion,changes in myocardial injury biomarker levels,cardiac function recovery,and prognosis of the two groups of patients were compared.【Results】Under different treatment regimens,the proportion of thrombolysis in myocardial infarction(TIMI)grade 3 and TIMI myocardial perfusion grade(TMPG)3 in the bivalirudin group was 85.71%(48/56)and 91.07%(51/56),higher than the heparin group[62.50%(35/56)and 67.86%(38/56)](P<0.05).The corrected TIMI frame count(cTFC)of the bivalirudin group(30.23±5.24)was lower than the heparin group(33.46±5.33),with a PI of 55.62%±10.44% higher than the heparin group(50.35%±10.21%)(P<0.05).The myoglobin(MYO),creatine kinase myocardial band(CK-MB),and lactate dehydrogenase(LDH)of the bivalirudin group were 61.23±10.41μg/L,10.25±2.31 U/L,and 40.22±10.25 U/L,all lower than those in the heparin group(66.43±10.28μg/L,12.41±3.25 U/L,45.62±10.31 U/L)(P<0.05).The left ventricular ejection fraction(LVEF)of the bivalirudin group(55.18%±10.29%)was higher than the heparin group(50.31%±10.24%),and the left ventricular end-diastolic volume(LVEDV)and left ventricular end-systolic volume(LVESV)(115.32±20.33 mL and 55.27±10.25 mL)were lower than the heparin group(130.25±20.32 mL and 60.41±10.28 mL)(P<0.05).The incidence of adverse prognosis in the bivalirudin group was 5.36%(3/56),lower than

关 键 词：急性心肌梗死 溶栓失败 经皮冠脉介入术 比伐卢定 心肌灌注 

分 类 号：R542.22[医药卫生—心血管疾病]