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目的探讨比伐卢定对急性ST段抬高型心肌梗死患者冠脉复流、心肌灌注影响。方法将急性ST段抬高型心肌梗死患者120例,依据急诊PCI时抗凝方法分为观察组与对照组各60例。观察组急诊PCI术前静脉给予负荷量比伐卢定0.75mg/kg,然后给予1.75mg/(kg·h)持续泵注4h,最后给予0.2mg/(kg·h)维持治疗16h;对照组在急诊PCI术前给予动脉鞘管内注射肝素3000U,PCI结束前共给予肝素10 000U。观察2组患者冠脉复流TIMI 3级比例、校正TIMI计数、TIMI心肌灌注血流染色分级比例、ST段抬高回落幅度百分比(%)。结果治疗后2组患者TIMI 3级比例、TIMI心肌灌注分级比例及校正TIMI计数比较差异均无统计学意义(P>0.05)。治疗后2组患者ST段抬高回落幅度百分比>70%[例(%)],差异无统计学意义(P>0.05)。2组患者围术期及术后30d主要心脏不良事件发生率差异无统计学意义(P>0.05)。结论比伐卢定可安全用于急性ST段抬高型心肌梗死患者急诊PCI治疗,改善心肌血流灌注,与普通肝素组比较,临床作用效果相当。
Objective To investigate the effect of bivalirudin on coronary perfusion and myocardial perfusion in patients with acute ST-segment elevation myocardial infarction. Methods A total of 120 acute ST-segment elevation myocardial infarction patients were divided into observation group and control group according to the anticoagulation method of emergency PCI respectively. The patients in the observation group were given intravenous infusion of bivalirudin 0.75mg / kg intravenously before emergency PCI, and then were given a continuous infusion of 1.75mg / (kg · h) for 4h. Finally, 0.2mg / (kg · h) In the emergency PCI prior to arterial sheath injection of heparin 3000U, before the end of PCI were given heparin 10 000U. TIMI grade 3, TIMI count, TIMI myocardial perfusion staining grade ratio, ST segment elevation fall percentage (%) were observed in 2 groups. Results There was no significant difference of TIMI grade 3, TIMI myocardial perfusion grade and corrected TIMI between the two groups after treatment (P> 0.05). There was no significant difference (P> 0.05) between the two groups of patients after treatment, the percentage of ST segment elevation dropped by more than 70% [cases (%]]. There was no significant difference in the incidence of major cardiac adverse events between the two groups during perioperative period and 30 days after operation (P> 0.05). Conclusion Bivalirudin can be safely used in patients with acute ST-elevation myocardial infarction in emergency PCI, improve myocardial perfusion, compared with unfractionated heparin group, the clinical effect is quite.