【摘要】 目的 观察比伐卢定对急性ST段抬高型心肌梗死(STEMI)患者急诊经皮冠状动脉介入(PCI)术后的疗效和抗炎作用。方法 连续选取2015年10月1日至2016年9月30日于泰达国际心血管病医院拟行急诊PCI术的STEMI患者107例,根据术中抗凝药物种类分为肝素组(55例)和比伐卢定组(52例)。比较2组患者术后24 h、7 d时高敏C反应蛋白(hs-CRP)和脂蛋白相关磷脂酶A2(Lp-PLA2)水平,以及术后30 d出血事件和主要不良心脏事件(MACE)的发生率。结果 术后7 d,比伐卢定组hs-CRP水平明显低于肝素组[(3.5±2.4)mg/L比(5.4±3.9)mg/L],差异有统计学意义(P<0.01);Lp-PLA2水平低于肝素组[(161±73)μg/L比(173±80)μg/L],但差异无统计学意义(P>0.05)。比伐卢定组术后30 d出血发生率明显低于肝素组[1.9%(1/52)比16.4%(9/55)],差异有统计学意义(P=0.01);MACE发生率低于肝素组[3.8%(2/52)比12.7%(7/55)],但差异无统计学意义(P=0.10)。结论 急性STEMI接受急诊PCI的患者,术中使用比伐卢定抗凝,能明显减少术后出血并发症,并在一定程度上减轻炎性反应。更多还原

【Abstract】 Objective To observe the effect of bivalirudin on inflammatory factors in patients with ST-elevation myocardial infarction(STEMI) after percutaneous coronary intervention(PCI).Methods A total of107 patients undergoing PCI for STEMI were consecutively enrolled from October 1st 2015 to September 30 th2016.According to intraoperative use of anticoagulants,the patients were divided into heparin group(n=55) and bivalirudin group(n = 52).Levels of high-sensitivity C-reactive protein(hs-CRP) and lipoprotein-associated phospholipase A2(Lp-PLA2) were tested 24 h and 7 d after PCI.The 30 d incidences of bleeding events and major adverse cardiac events(MACE) were recorded.Results The level of hs-CRP 7 d post-inter vention in bivalirudin group was significantly lower than that in heparin group[(3.5 ±2.4) mg/L vs(5.4 ± 3.9) mg/L](P < 0.01);Lp-PLA2 level had no significant difference between groups[(161 ±73) μg/L vs(173 ± 80) μg/L](P > 0.05).The incidence of bleeding in 30 d post-inter vention in bivalirudin group was significantly lower than that in heparin group[1.9%(1/52) vs 16.4%(9/55)](P = 0.01);the incidence of MACE had no significant difference between groups[3.8%(2/52) vs 12.7%(7/55)](P = 0.10).Conclusion Intraoperative use of bivalirudin during PCI in patients with STEMI can significantly reduce postoperative bleeding and inflammatory response.更多还原