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ST段抬高型急性心肌梗死患者PCI术中应用比伐卢定对心功能的影响及其安全性研究

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摘要:

目的 探讨ST段抬高型急性心肌梗死(STEMI)患者经皮冠状动脉介入治疗(PCI)中应 用注射用比伐卢定对患者心功能影响及出血安全性。方法 选取2017年3月至2018年10月于济南市中心 医院确诊并拟行急诊PCI的STEMI患者102例作为研究对象,根据术中使用抗凝药物不同分为比伐卢定组 (n=51)和肝素组(n=51)。采用前瞻性、随机对照、单中心的临床试验设计方法。比较两组术后心功 能及并发症,评价比伐卢定应用于急诊PCI对心功能的影响及安全性。结果 术后24 h升主动脉内径,差 异具有统计学意义(P<0.05)。术后24 h室间隔厚度差异具有统计学意义(P<0.05)。术后24 h左室舒 张内经,差异具有统计学意义(P<0.05)。脑钠肽(BNP)水平差异无统计学意义(P>0.05);TNT水 平、差异无统计学意义(P>0.05),术后24 h肌酐水平差异无统计学意义(P>0.05)。术后24 h尿素水 平差异无统计学意义(P>0.05)。术后24 h的C反应蛋白,差异有统计学意义(P<0.05)。在凝血因子 水平变化方面改善作用更优[部分活化凝血酶原时间(APTT)水平比较P<0.05,凝血酶原时间(PT)水 平比较P<0.05]。结论 比伐卢定对STEMI患者急诊PCI术后心脏功能较肝素存在改善效果,但差异无统 计学意义,可能与炎症机制相关;比伐卢定用于PCI出血风险低。

Abstract:

Objective To investigate the effect of bivalirudin for injection on cardiac function and bleeding safety in patients with ST-segment elevation acute myocardial infarction (STEMI) in percutaneous coronary intervention (PCI). Methods A total of 102 STEMI patients who were diagnosed in Jinan Central Hospital from March 2017 to October 2018 and planned to undergo emergency PCI were selected as the research subjects. They were divided into bivalirudin groups (n=51) according to the different anticoagulant drugs used during the operation. And heparin group (n=51). A prospective, randomized, single-center clinical trial design method was used. Cardiac function and complications were compared between the two groups, and the effect and safety of bevacudine on cardiac function in emergency PCI were evaluated. Results The diameter of the ascending aorta was statistically significant at 24 hours after operation (P<0.05). The difference in ventricular septal thickness at 24 hours after operation was statistically significant (P<0.05). 24 hours after operation, the left ventricular diastolic internal meridian was significantly different (P<0.05). There was no significant difference in BNP levels (P>0.05). There was no significant difference in TNT level (P>0.05). There was no significant difference in creatinine level at 24 hours after operation (P>0.05). There was no significant difference in urea level at 24 hours after operation (P>0.05). There was a statistically significant difference in C-reactive protein at 24 hours postoperatively (P<0.05).The improvement of coagulation factor level was better (APTT level P<0.05, PT level P<0.05). Conclusion Bivalirudin improves cardiac function compared with heparin after emergency PCI in patients with STEMI, but the difference is not statistically significant, which may be related to the inflammation mechanism. Bivalirudin has a lower risk of bleeding in PCI.

基金项目:

国家自然科学基金(81170087)

参考文献:

  • 2008

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