2021 年第 2 期 第 16 卷

比伐芦定和替罗非班在急性ST段抬高型心肌梗死患者行急诊经皮冠状动脉介入术中的抗凝效果比较

Comparison of anticoagulant effect between bivalirudin and tirofiban in emergency percutaneous coronary intervention in patients with ST-segment elevation myocardial infarction

作者：李秀芬姜述斌路璐帕尔哈提·吐尔逊

英文作者：Li Xiufen Jiang Shubin Lu Lu Parhati Turson

单位：新疆医科大学附属中医医院心脏中心，乌鲁木齐 830001

英文单位：Heart Center Xinjiang Medical University Affiliated Hospital of Traditional Chinese Medicine Urumqi 830001 China

关键词：急性ST段抬高型心肌梗死；经皮冠状动脉介入治疗；比伐芦定；替罗非班 

英文关键词：AcuteST-segmentelevationmyocardialinfarction；Percutaneouscoronaryinterventions；Bivalirudin；Tirofiban

• 摘要：

• 目的 比较比伐芦定和替罗非班在急性ST段抬高型心肌梗死(STEMI)患者行急诊经皮冠状动脉介入（PCI）术中的抗凝效果。方法 选取2019年1月至2020年1月于新疆医科大学附属中医医院诊断为STEMI，且发病12 h内行急诊PCI治疗的住院患者110例，完全随机分为观察组和对照组，各55例。观察组予以比伐芦定进行抗凝，对照组予以替罗非班进行抗凝，比较2组患者在停止注射比伐芦定/替罗非班后5、30 min和1、2 h的活化凝血时间（ACT）,记录术后即刻心肌梗死溶栓试验(TIMI)血流分级、TIMI心肌灌注分级(TMPG)、术后1周超声心动图指标。记录随访30 d内出血事件、主要不良心血管事件（MACE）发生情况。采用Kaplan-Meier生存曲线比较2组随访期间的无事件生存率。结果 观察组停药后5、30 min ACT均长于治疗前，且停药后5 min ACT长于对照组［（343±34）s比（313±29）s］，停药后30 min和1、2 h ACT均短于对照组［（232±24）s比（289±38）s、（157±18）s比（270±20）s、（149±16）s比（257±19）s］（均P＜0.05）。观察组TIMI 3级及TMPG 3级比例均高于对照组，差异均有统计学意义［96.4%（53/55）比83.6%（46/55）、92.7%（51/55）比72.7%（40/55）］（均P＜0.05）。观察组左心室射血分数高于对照组，左心室收缩末期内径和左心房内径低于对照组，差异均有统计学意义（均P＜0.05）。观察组出血事件以及MACE发生率均低于对照组，Kaplan-Meier生存曲线分析结果显示，随访30 d时，观察组无事件生存率高于对照组，差异均有统计学意义（均P＜0.05）。结论 比伐芦定在STEMI患者PCI术中的抗凝效果较好，能明显改善患者的冠状动脉血流和心肌再灌注，且安全性较好。

• Objective To compare the anticoagulant effect of bivalirudin and tirofiban on emergency percutaneous coronary interventions (PCI) in ST-segment elevation myocardial infarction (STEMI) patients. Methods From January 2019 to January 2020, 110 inpatients with STEMI underwent emergency PCI within 12 h of onset in Xinjiang Medical University Affiliated Hospital of Traditional Chinese Medicine were selected and randomly divided into observation group and control group, with 55 cases in each group. The observation group was treated with bivalirudin for anticoagulation and the control group was treated with  tirofiban for anticoagulation. The activated clotting time (ACT) at 5, 30 min and 1, 2 h after stopping injection of bivalirudin/tirofiban were compared between the two groups. Thrombolysis in myocardial infarction(TIMI) grade, TIMI myocardial perfusion grade (TMPG) and echocardiography at 1 week after operation were recorded. Hemorrhage events and major adverse cardiovascular events（MACEs） within 30 d of follow-up period were recorded. Kaplan-Meier survival curve was used to compare the event-free survival rates between the two groups during the follow-up period. Results  The ACT of observation group at 5 and 10 min after stopping injection were longer than those before treatment, and the ACT of observation group at 5 min after stopping injection was longer ［（343±34）s vs （313±29）s］, and at 30 min and 1, 2 h after stopping injection the ACT of observation group were shorter than those of control group［（232±24）s vs （289±38）s,（157±18）s vs （270±20）s,（149±16）s vs （257±19）s］（all P＜0.05）. The proportion of TIMI grade 3 and TMPG grade 3 in observation group were higher than those in control group［96.4%（53/55） vs 83.6%（46/55）, 92.7%（51/55） vs 72.7%（40/55）］（both P＜0.05）. The left ventricular ejection fraction  of observation group was significantly higher, and the left ventricular end systolic diameter and left atrial diameter were significantly lower than those of control group, and the differences were significant statistically (all P＜0.05). The incidences of hemorrhagic events and MACEs of observation group were lower than those of control group. Kaplan-Meier survival curve analysis showed that the event-free survival rate of observation group was higher than that of control group at 30 d of follow-up, and the differences were significant statistically (all P<0.05). Conclusions Bivalirudin has better anticoagulant effect in STEMI patients during PCI.  It can significantly improve coronary blood flow and myocardial reperfusion in patients with safety.