摘要
目的研究比伐卢定联合挽救性经皮冠状动脉介入术(PCI)治疗老年急性心肌梗死溶栓失败患者的疗效及预后。方法回顾性选择2018年6月至2021年6月在沧州市中心医院接受挽救性PCI治疗的92例老年急性心肌梗死溶栓失败患者,根据抗凝药物不同分为比伐卢定组(n=42)和对照组(n=50)。比伐卢定组使用比伐卢定抗凝,对照组使用肝素抗凝。分析梗死相关动脉(IRA)再通率及校正的TIMI血流帧数(CTFC),治疗后2 h和4 h的心电图ST段回落率,治疗后24 h的血清磷酸肌酸激酶同工酶(CK-MB)、心肌肌钙蛋白I(cTnI)、乳酸脱氢酶(LDH)水平,治疗后7 d的左心室射血分数(LVEF)、左心室收缩末期容积(LVESV)、左心室舒张末期容积(LVEDV);随访治疗后1年内主要不良心血管事件(MACE)的累积发生率。结果比伐卢定组的IRA再通率、即刻CTFC水平为80.95%、(29.39±5.32)帧数,均高于对照组[54.00%、(24.41±4.59)帧数],差异均有统计学意义(P<0.05)。比伐卢定组治疗后2 h和4 h时的ST段回落率为69.05%、80.95%,均高于对照组(46.00%、58.00%),差异均有统计学意义(P<0.05)。比伐卢定组的血清CK-MB、cTnI、LDH水平为(7.59±1.23)U/L、(0.41±0.07)ng/mL、(127.58±22.58)U/L,均低于对照组[(12.14±2.03)U/L、(0.94±0.13)ng/mL、(162.38±24.85)U/L],差异均有统计学意义(P<0.05)。比伐卢定组治疗后7 d的LVEF水平为(54.57±8.12)%,均高于对照组[(51.03±6.68)%],LVESV、LVEDV为(39.59±7.23)、(80.13±12.52)mL,低于对照组[(46.51±7.65)mL、(93.41±13.48)mL],差异均有统计学意义(P<0.05)。随访过程中,比伐卢定组的MACE累积发生率低于对照组,差异有统计学意义(P<0.05)。结论比伐卢定联合挽救性PCI治疗老年急性心肌梗死溶栓失败患者的疗效确切,能够改善心肌血流灌注及预后。
Objective To study the efficacy and prognosis of bivalirudin combined with salvage percutaneous coronary intervention(PCI)in the treatment of elderly acute myocardial infarction patients with thrombolytic failure.Methods A total of 92 elderly acute myocardial infarction patients with thrombolytic failure who received salvage PCI in Cangzhou Central Hospital from June 2018 to June 2021 were retrospectively divided into bivalirudin group(n=42)and heparin control group(n=50)according to different anticoagulants.The bivalirudin group was anticoagulated with bivalirudin,and the control group was anticoagulated with heparin.The recanalization rate and corrected TIMI flow frame count(cTFC)of infarct related artery(IRA),ST segment fall rate of ECG at 2 h and 4 h after treatment,serum phosphocreatine kinase isoenzyme(CK-MB),cardiac troponin I(cTnI)and lactate dehydrogenase(LDH)levels at 24 h after treatment,left ventricular ejection fraction(LVEF),left ventricular end systolic volume(LVESV)and left ventricular end diastolic volume(LVEDV)at 7 d after treatment were analyzed.The cumulative incidence of major adverse cardiovascular events(MACE)within 1 year after treatment was followed up.Results The IRA recanalization rate,level of immediate CTFC of the bivalirudin group were 80.95%,(29.39±5.32)frames,which were higher than those of the control group[54.00%,(24.41±4.59)frames],and the differences were statistically significant(P<0.05).The ST segment regression rates of the bivalirudin group at 2 h and 4 h after treatment were 69.05%and 80.95%,which were higher than those of the control group(46.00%and 58.00%),and the differences were statistically significant(P<0.05).The levels of serum CK-MB,cTnI and LDH in the bivalirudin group were(7.59±1.23)U/L,(0.41±0.07)ng/mL,and(127.58±22.58)U/L,which were lower than those in the control group[(12.14±2.03)U/L,(0.94±0.13)ng/mL,(162.38±24.85)U/L],the differences were statistically significant(P<0.05).The level of LVEF of the bivalirudin group at 7 days after treatment was(54.57
作者
冉晨光
韩佳
赵娜
RAN Chen-guang;HAN Jia;ZHAO Na(Department of ECG Examination,Cangzhou Central Hospital,Cangzhou Hebei 061001,China;Department of Cardiovascular Medicine,Cangzhou Central Hospital,Cangzhou Hebei 061001,China)
出处
《临床和实验医学杂志》
2022年第7期699-702,共4页
Journal of Clinical and Experimental Medicine
基金
河北省沧州市科技计划项目(编号:162302018)。
关键词
急性心肌梗死
溶栓失败
比伐卢定
挽救性经皮冠状动脉介入术
预后
Acute myocardial infarction
Thrombolysis failure
Bivalirudin
Salvage percutaneous coronary intervention
Prognosis
