比伐卢定联合挽救性经皮冠状动脉介入治疗急性心肌梗死溶栓失败患者的疗效及安全性

目的探讨比伐卢定联合挽救性经皮冠状动脉介入治疗(PCI)治疗急性心肌梗死(ACI)溶栓失败患者的疗效及安全性。方法选取2017年9月至2020年6月辽宁省人民医院收治的98例ACI患者作为研究对象,按随机数字表法分为对照组与观察组,各49例。对照组接受肝素+挽救性PCI治疗,观察组采用比伐卢定+挽救性PCI治疗。比较两组血管再通率、血清心肌损伤标志物肌酸激酶同工酶(CK-MB)、肌钙蛋白T(cTnT)、肌钙蛋白Ⅰ(cTnⅠ)、超声心动图心功能参数左室射血分数(LVEF)、每搏输出量(SV)、左室舒张功能比值(E/A),随访并记录主要不良心血管事件发生情况。结果治疗后,两组患者的血管再通率差异无统计学意义(χ^(2)=1.010,P=0.315);PCI术后,两组血清CK-MB、cTn T、cTnⅠ水平及超声LVEF、SV、E/A水平差异无统计学意义(t=1.283、1.163、0.795、0.351、0.309、0.471,P=0.101、0.124、0.214、0.363、0.379、0.319)。随访期间,观察组主要不良心血管事件发生率低于对照组患者(χ^(2)=4.009,P=0.045)。结论伐卢定联合挽救性PCI用于急性心肌梗死溶栓失败患者的治疗,疗效与普通肝素相当,但在治疗安全性方面具有一定优势。

Efficacy and Safety of Bivalirudine Combined with Rescue PCI in Patients with Failed Thrombolytic Therapy for Acute Myocardial Infarction

Objective To investigate the efficacy and safety of bivalirudine combined with rescue PCI in patients with failed thrombolytic therapy for acute myocardial infarction.Methods A total of 98 ACI patients treated in Liaoning Provincial People’s Hospital during September 2017 to June 2020 were selected as the research objects and were randomly divided into a control group and an observation group,with 49 cases in each group.The control group treated with heparin+rescue PCI,and the observation group treated with bivaludine+rescue PCI.The blood vessel recanalization rate,serum cardiac injury markers CKMB,cTnT,cTnⅠ,echocardiographic cardiac function parameters left ventricular ejection fraction(LVEF),stroke output(SV),left ventricular diastolic function ratio(E/A)were compared between 2 groups after treatment.The occurrence of major adverse cardiovascular events was followed up and recorded.Results After treatment,there was no significant difference in the recanalization rate between 2 groups(χ²=1.010,P=0.315);there were no significant difference in serum CKMB,cTnT,cTnⅠlevels and ultrasound LVEF,SV,E/A levels(t=1.283,1.163,0.795,0.351,0.309,0.471,P=0.101,0.124,0.214,0.363,0.379,0.319).During the follow-up period,the incidence of major adverse cardiovascular events in the observation group was lower than that in the control group.Conclusion Valrudin combines with rescue PCI in the treatment of thrombolytic failure of acute myocardial infarction,which has same efficacy as heparin,but it has certain advantages in treatment safety.