摘要
目的:观察比伐芦定对急性冠脉综合征(ACS)经皮冠状动脉介入术(PCI)术病人凝血功能、心肌梗死溶栓试验(TIMI)血流分级及心肌缺血标志物的影响。方法:选取2020年7月—2022年7月青岛市胶州中心医院收治的拟行PCI术的ACS病人,按照围术期抗凝用药方案不同分为肝素组(给予肝素抗凝)和比伐芦定组(给予比伐芦定抗凝),经倾向性匹配评分(卡钳值0.02)筛选出基线资料均衡可比病人,两组各纳入60例病人,比较两组活化凝血时间(ACT)值、TIMI血流分级及术后出血情况;比较两组术前、术后24 h凝血功能指标[促凝血酶原时间(APTT)、凝血酶时间(TT)、凝血酶原时间(PT)及纤维蛋白原(FIB)]、心肌缺血标志物[肌钙蛋白T(cTnT)、缺血修饰白蛋白(IMA)和血清miR-204];比较两组术前、术后4周心脏功能指标[左心室射血分数(LVEF)、左室舒张末内径(LVEDD)、左室舒张末容积(LVEDV)和左房直径(LA)]变化以及随访1年内主要心血管不良事件(MACE)发生率。结果:注射药物后5 min、术后即刻、停止注射后2 h,比伐芦定组ACT值明显高于肝素组(P<0.05);比伐芦定组术后出血发生率为3.33%,低于肝素组的13.33%(P<0.05);术后24 h,两组APTT、TT、PT水平明显延长(P<0.05),FIB水平明显降低(P<0.05),且比伐芦定组APTT、TT、PT较肝素组延长(P<0.05),FIB水平低于对照组(P<0.05)。术后即刻、术后7 d,比伐芦定组TIMI血流分级优于肝素组(P<0.05);术后24 h,两组cTnT、IMA水平均明显降低(P<0.05),miR-204水平明显升高(P<0.05),且比伐芦定组改善程度明显优于肝素组(P<0.05);术后4周,两组病人LVEF水平均明显升高(P<0.05),LVEDD、LVEDV、LA水平均明显降低(P<0.05),且比伐芦定组改善程度明显优于肝素组(P<0.05)。术后1年,比伐芦定组不良心血管事件(MACE)发生率为11.67%,低于肝素组的23.33%,但两组比较差异无统计学意义(P>0.05)。结论:比伐芦定应用于ACS病人PCI治疗,可明显降低病人�
Objective:To observe the effects of bivarudine on coagulation function,thrombolysis in myocardial infarction(TIMI)and myocardial ischemia markers in patients with acute coronary syndrome(ACS)after percutaneous coronary intervention(PCI).Methods:ACS patients were divided into heparin group(treated with heparin for anticoagulation)and bivarudine group(treated with bivarudine for anticoagulation)according to different perioperative anticoagulation medication regimens.Patients with comparable baseline data with balanced data were screened by tendency matching score(callipers value 0.02).Sixty patients were included in each group.The values of activated coagulation time(ACT),TIMI blood grading and postoperative bleeding were compared between the two groups.The indexes of coagulation function[prothrombin time(APTT),thrombin time(TT),prothrombin time(PT)and fibrinogen(FIB)],myocardial ischemia markers[troponin T(cTnT),ischemia modified albumin(IMA)and serum miR-204]of the two groups were compared before and 24 h after surgery.The changes of cardiac function parameters[left ventricular ejection fraction(LVEF),left ventricular end-diastolic diameter(LVEDD),left ventricular end-diastolic volume(LVEDV)and left atrial diameter(LA)]before and 4 weeks after surgery and the incidence of major adverse cardiovascular events(MACE)within 1 year of follow-up were compared between the two groups.Results:At 5 min after injection,immediately after operation and 2 h after stopping injection,the ACT of bivarudine group was higher than that of heparin group(P<0.05).The incidence of postoperative bleeding in the bivarudine group was 3.33%,which was less than that in heparin group(13.33%,P<0.05).24 h after operation,APTT,TT and PT significantly increased(P<0.05),FIB significantly decreased(P<0.05),and APTT,TT and PT in the bivarudine group were more than those in the heparin group(P<0.05),FIB levels were lower than those in the heparin group(P<0.05).At surgery and 7 days after surgery,the TIMI blood flow grading of bivarudine group was bett
作者
韩爱娜
王春良
张迎中
HAN Aina;WANG Chunliang;ZHANG Yingzhong(Jiaozhou Central Hospital of Qingdao,Qingdao 266300,Shandong,China)
出处
《中西医结合心脑血管病杂志》
2024年第15期2839-2843,共5页
Chinese Journal of Integrative Medicine on Cardio-Cerebrovascular Disease
关键词
急性冠脉综合征
经皮冠状动脉介入术
比伐芦定
凝血功能
心肌缺血
acute coronary syndrome
percutaneous coronary intervention
bivarudine
coagulation function
myocardial ischemia
