比伐卢定在老年急性心肌梗死患者急诊行经皮冠状动脉介入术中的效果

Efficacy of bivalirudine in emergency percutaneous coronary intervention for elderly patients with acute myocardial infarction

摘要:

目的 研究比伐卢定在老年急性心肌梗死患者急诊行经皮冠状动脉介入(PCI)治疗术中的效果。方法 入选2017年4月至2018年12月武汉亚洲心脏病医院接受PCI术的急性ST段抬高型心肌梗死(STEMI)患者124例,随机数表法分为研究组和对照组,每组62例。2组患者术前给予同样剂量阿司匹林和氯吡格雷口服,术中对照组经静脉给予普通肝素,研究组给予比伐卢定。比较2组患者术前和术后30d左心室射血分数(LVEF)、左心室舒张末期内径(LVEDD)、B型利钠肽(BNP)、出血事件以及住院期间、术后30d和60d主要不良心血管事件(MACEs)。应用SPSS 18.0统计软件对数据进行分析。依据数据类型,采用t检验或χ²检验进行组间比较。结果 2组患者术前LVEF、LVEDD、BNP水平差异无统计学意义(P＞0.05)。相比术前,2组患者术后30d LVEF水平均升高,LVEDD和BNP水平下降,且研究组相比对照组LVEF、BNP[(46.9±4.7)%和(43.1±4.5)%；(182.8±83.4)和(294.5±107.6)ng/L]水平改善明显,差异均有统计学意义(P＜0.05)。术前,研究组1例轻度出血,对照组1例轻度出血,1例中/重度出血,差异无统计学意义(P＞0.05)。研究组相比对照组术后30d出血发生率[3.23%(2/62)和6.45%(4/62)]明显降低,差异有统计学意义(χ²＝5.145；P＜0.05)。研究组与对照组术后30d和60d的MACEs发生率[1.61%(1/62)和3.23%(2/62)；3.23%(2/62)和4.84%(3/62)]差异均无统计学意义(χ²＝1.290,χ²＝0.112；P＞0.05)。结论 比伐卢定可改善行PCI术急性心肌梗死患者心功能指标,并显著减少PCI术后出血事件的发生。

Abstract:

Objective To study the efficacy of bivalirudine in emergency percutaneous coronary intervention (PCI) in the elderly patients with acute myocardial infarction. Methods Enrolled in the study were a total of 124 ST-elevation myocardial infarction (STEMI) patients who underwent PCI in Wuhan Asian Heart Hospital from April 2017 to December 2018. They were randomized into the study group and the control group, with 62 in each group.The two groups were given the same dose of aspirin and clopidogrel orally before operation, and the patients in the control group were given heparin intravenously and the patients in the study group bivalirudin during the operation. The two groups were compared in left ventricular ejection fraction (LVEF), left ventricular end-diastolic diameter (LVEDD), B-type natriuretic peptide (BNP), bleeding events and major adverse cardiovascular events (MACEs) during hospitalization, 30d and 60d after operation. SPSS statistics 18.0 was used for data analysis.Depending on the data type,t test or Chi-square test was used for comparison between groups. Results The two groups had no significant difference in preoperative LVEF, LVEDD and BNP (P>0.05). Compared with pre-operative levels, LVEF increased and LVEDD and BNP decreased at 30d after operation in both groups. Compared with the control group, the LVEF [(46.9±4.7)% vs (43.1±4.5)%] and BNP [(182.8± 83.4) vs (294.5±107.6)ng/L] improved significantly in the study group (P<0.05). Before operation, mild hemorrhage was observed in 1 patient in the study group and 1 patient in the control group, and 1 had moderate/severe hemorrhage in the control group. The difference was not statistically significant (P>0.05). At postoperative 30d, the incidence of hemorrhage in the study group was significantly lower than that in the control group[3.23%(2/62) vs 6.45%(4/62)]. The difference was statistically significant(χ²= 5.145; P<0.05). Therewas no significant difference in the incidence of MACEs[1.61%(1/62) vs 3.23%(2/62); 3.23%(2/62) vs 4.84%(3/62)]between the study group and the control group (χ²＝1.290,χ²＝0.112; P＞0.05). Conclusion Bivalirudine can improve cardiac functions in the patients with acute myocardial infarction undergoing PCI and significantly reduce the incidence of hemorrhage after PCI.