摘要
目的：比较比伐卢定与血小板糖蛋白Ⅱb/Ⅲa受体拮抗剂替罗非班加肝素在急诊经皮冠状动脉介入治疗（PCI）中的疗效及安全性。方法：55例接受急诊PCI治疗的急性ST段抬高型心肌梗死患者（STEMI）,随机分为比伐卢定组（23例）和替罗非班加肝素组（32例）。所有患者在发病12 h内行急诊PCI术,比伐卢定组：在急诊PCI术前静脉给予比伐卢定负荷量0.75 mg/kg,术中以1.75 mg/（kg·h）持续静脉点滴,术后以0.2 mg/（kg·h）持续静脉点滴4-20 h。替罗非班加肝素组：术前静脉内注入10μg/kg替罗非班,然后以0.075μg/（kg·h）持续静脉滴注24-36 h,同时静脉内注入普通肝素100 U/kg。观察两组PCI术后心肌梗死溶栓治疗临床试验（TIMI）血流分级,2 h心电图ST段回落百分比,两组出血的发生率。结果：比伐卢定组与替罗非班加肝素组ST段回落百分比（91.3%和93.7%）,TIMI 3级血流比例（95.9%和96.8%）,差异均无统计学意义（P〉0.05）;比伐卢定组出血发生率明显低于替罗非班加肝素组（0%和18.75%）,但差异无统计学意义（P〉0.05）。结论：急性ST段抬高型心肌梗死患者直接PCI时,比伐卢定与替罗非班加肝素相比有相同的疗效,临床出血率低,但统计学差异不明显,可能与样本量少有关。
Objective： To compare the efficacy and safety between bivalirudin and tirofiban plus heparin in patients undergoing emergent primary pereutaneous coronary intervention（ PCI）. Methods： Patients with acute ST segment elevation myocardial infraction（ STEMI） received primary PCI were randomly divided into 2 groups,i. e.,bivalirudin group（ n = 23） and tirofiban plus heparin group（ n = 32）. The patients in bivalirudin group received bivalirudin in dose of 0. 75 mg / kg,followed by intraoperative infusion of bivalirudin in dose of 1. 75 mg /（ kg·h）,and postoperative continuous intravenous drip of this agent in dose of 0. 2 mg /（ kg·h） for 4 to 20 hours. While tirofiban plus heparin group were given tirofiban in dose of 10 μg / kg,followed by continuous infusion of tirofiban in dose of 0. 075 μg / kg. h for 24 to 36 hours,and heparin（ 100 U / kg） was simultaneously administered in PCI. The two groups were observed regarding ST-segment resolution（ STR） at 2 hour after PCI,thrombelysis in myocardial infarction（ TIMI） flow grading and incidence of bleeding.Results： The difference was not significant in sum STR and TIMI flow grading for the two groups（ P〈0. 05）. Although bivalirudin group had significantly lower incidence of bleeding than tirofiban plus heparin group,yet the difference was not significant（ P〉0. 05）. Conclusion： Bivalirudin and tirofiban plus heparin may produce the similar effects on STEMI patients during primary PCI,and lead to lower incidence of bleeding. However,the difference is not statistically different,which may be associated with lower samples in current study.
出处
《皖南医学院学报》
CAS
2015年第3期258-261,共4页
Journal of Wannan Medical College
