摘要
目的:比较比伐芦定与替罗非班联合肝素治疗急性ST段抬高型心肌梗死(STEMI)合并糖尿病的临床效果。方法:选择195例STEMI合并糖尿病的临床资料进行回顾性研究,按治疗方案不同分为比伐芦定组(100例)和替罗非班组(95例)。两组患者均在发病12 h内行急诊经皮冠状动脉介入治疗(PCI)并于PCI前后常规口服阿司匹林和氯吡格雷等;比伐芦定组患者在PCI前静脉注射0.75 mg/kg负荷剂量的比伐芦定,术中持续静脉滴注1.75 mg/(kg·h)的比伐芦定直至手术结束;替罗非班组患者于PCI前静脉注射100 U/kg普通肝素和10μg/kg替罗非班,术中持续静脉滴注0.75μg/(kg·h)的替罗非班,连续36 h。比较两组患者PCI术后再灌注指标、心脏彩超监测指标和安全性,并比较两组患者治疗前后的血清脑钠肽(BNP)含量。结果:两组患者PCI术后即刻的心肌梗死溶栓试验(TIMI)血流分级、TIMI血流计帧、血清肌酸激酶同工酶峰值及达峰时间、ST段回落百分比,治疗后7、30 d的血清BNP含量与左心室射血分数、左心室收缩末期内径、左心室舒张末期内径比较,差异均无统计学意义(P>0.05)。替罗非班组患者的心脏不良事件发生率为36.8%,比伐芦定组为41.0%,差异无统计学意义(P>0.05);替罗非班组患者的出血率为24.2%,比伐芦定组为7.0%,差异有统计学意义(P<0.05)。结论:比伐芦定与替罗非班联合肝素治疗STEMI合并糖尿病的临床效果相当,但比伐芦定可明显减少出血事件的发生。
OBJECTIVE：To compare clinical efficacy of bivalirudin vs. tirofiban combined with heparin in the treatment of acute ST elevation myocardial infarction（STEMI）complicated with diabetes mellitus（DM）. METHODS：195 patients diagnosed as STEMI complicated with DM were selected for retrospective study,and divided into bivalirudin group（100 cases）and tirofiban group（95 cases）according to the different treatment plan. All patients received emergency PCI within 12 hours and conventionally took aspirin and clopidogrel before and after PCI. Bivalirudin group was given bivalirudin 0.75 mg/kg intravenously before PCI,and continuous intravenous dripping of 1.75 mg/（kg·h）till the end of operation. Tirofiban group was given heparin 100 U/kg and tirofiban 10 μg/kg intravenously before PCI,and continuous intravenous dripping of 0.75 μg/（kg·h）tirofiban for 36 h. Postoperative reperfusion indexes,UCG monitoring indexes and safety were compared between 2 groups,and the content of serum BNP were compared before and after treatment. RESULTS：For the TIMI grade,TIMI frame count,the peak of CK-MB and peak time,ST segment decline percentage immediately after PCI,contents of serum BNP,LVEF,LVESD,LVEDD 7,30 d after treatment,the differences were not statistically significant between 2 groups（P〉0.05）. The incidence of MACE events was 36.8% in tirofiban group and 41.0% in bivalirudin group,there was no statistical significance between 2 groups（P〉0.05）. The incidence of bleeding events was 24.2% in tirofiban group and 7.0% in bivalirudin group,the difference was statistically significant（P〈0.05）. CONCLUSIONS：Bivalirudin and tirofiban combining with heparin have same efficacy in the treatment of STEMI complicated with DM,while bivalirudin may significantly reduce the incidence of bleeding events during primary PCI.
出处
《中国药房》
CAS
北大核心
2016年第26期3671-3674,共4页
China Pharmacy
