中国药物警戒 ›› 2019, Vol. 16 ›› Issue (5): 260-264.

• 基础与临床研究 • 上一篇    下一篇

比伐卢定联合替罗非班对急性ST段抬高型心肌梗死患者冠状动脉介入术中无复流或慢血流的探索性应用

郭晓丽   

  1. 商丘市中医院心内科,河南 商丘 476000
  • 收稿日期:2018-10-22 修回日期:2019-06-11 出版日期:2019-05-20 发布日期:2019-06-11
  • 作者简介:郭晓丽,女,本科,副主任医师,冠心病研究。

Application of Bivaludine Combined with Tirofiban in Patients with STEMI without Reflow or Slow Blood Flow during Coronary Intervention

GUO Xiaoli   

  1. Department of Cardiology, Shangqiu City Hospital of TCM, Henan Shangqiu 476000, China
  • Received:2018-10-22 Revised:2019-06-11 Online:2019-05-20 Published:2019-06-11

PDF (PC)

87

摘要： 目的 观察比伐卢定联合替罗非班冠状动脉内序贯应用对急性ST段抬高型心肌梗死（STEMI）患者冠状动脉介入术（PCI）中无复流或慢血流的影响。方法 选择在比伐卢定抗凝下直接PCI术中出现无复流或慢血流的STEMI患者108例,根据术中抗凝药物使用的不同,分为冠脉A组36例、冠脉B组38例、冠脉C组34例。比较3组在PCI术后冠状动脉血流分级、ST段回落情况、左心室舒张末内径（LVEDD）、左室射血分数（LVEF）。评定比较各组的主要不良心血管事件（MACE）及住院期间的出血事件、血小板减少发生率。结果 3组术中及术后TIMI 3级及ST段完全回落比例均以冠脉A组最高,冠脉C组最低,差异有统计学意义（P<0.05）。各组PCI术后3个月和6个月的LVEDD逐渐缩短,LVEF逐渐增加。术后6个月,LVEDD以冠脉A组最短,冠脉C组最长,LVEF以冠脉A组最大,冠脉C组最小,差异均有统计学意义（P<0.05）。冠脉A组、冠脉B组、冠脉C组的出血事件发生率分别为8.33%、5.26%、5.88%,差异无统计学意义（P>0.05）。PCI术后1月内冠脉A组、冠脉B组、冠脉C组的MACE的发生率分别为13.89%、31.58%、41.18%,其中冠脉A组的MACE发生率显著低于冠脉B组和冠脉C组（P<0.05）,而冠脉B组和冠脉C组之间的差异无统计学意义（P>0.05）。冠脉A组、冠脉B组、冠脉C组的血小板减少程度差异无统计学意义（P>0.05）。结论 冠脉内序贯应用比伐卢定及替罗非班在STEMI行PCI中疗效显著,且不增加出血及血小板减少风险,可显著提高患者近期临床疗效。

关键词: 比伐卢定, 替罗非班, ST段抬高型心肌梗死, 经皮冠状动脉介入治疗

Abstract: Objective To observe the effect of sequential intracoronary infusion of bivalirudin and tirofiban on no-reflow or slow blood flow in patients with acute ST-segment elevation myocardial infarction(STEMI) undergoing coronary artery intervention. Methods 108 STEMI patients undergoing no-reflow or slow blood flow during anticoagulation with bivalirudin, according to the different use of anticoagulants during operation, were divided into three groups including coronary artery group A (36 cases), coronary artery group B (38 cases) and coronary artery group C (34 cases). Coronary blood flow classification, ST-segment depression, left ventricular end diastolic diameter (LVEDD) and left ventricular ejection fraction (LVEF) were compared between the three groups after coronary angiography. The major adverse cardiovascular events (MACE) and the bleeding events during hospitalization and the incidence of thrombocytopenia were assessed. Results The proportions of TIMI 3 grade and ST-segment in the three groups were all highest in coronary artery group A, the lowest in coronary artery group C. The difference was statistically significant (P <0.05). At 3 months and 6 months after PCI, LVEDD gradually decreased and LVEF gradually increased. After 6 months, LVEDD was the shortest in coronary artery group A, and coronary artery group C was the longest. The LVEF coronary artery was the largest in coronary artery group A, and the smallest in coronary artery group C. The difference was statistically significant (P <0.05). The incidences of bleeding in coronary artery group A, B and C were 8.33%, 5.26% and 5.88%. The difference was not statistically significant(P>0.05). The incidences of MACE in coronary artery group A, B and C were 13.89%, 31.58% and 41.18%. Within 1 month after PCI, the incidence of MACE in coronary artery group A was significantly lower than that in coronary artery group B and coronary artery group C(P <0.05), but there was no significant difference between coronary artery group B and coronary artery group C (P >0.05). There was no significant difference in the thrombocytopenia among coronary artery group A, B and C (P >0.05). Conclusion Sequential intracoronary bivalirudin and tirofiban have significant efficacy in PCI with STEMI without increasing the risk of hemorrhage and thrombocytopenia, which can significantly improve the short-term clinical efficacy.

Key words: bivalirudin, tirofiban, ST-segment elevation myocardial infarction(STEMI), percutaneous coronary intervention(PCI)

中图分类号: