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目的比较急性ST段抬高型心肌梗死(STEMI)行直接经皮冠状动脉介入治疗(PCI)围术期静脉应用比伐芦定和普通肝素的安全性和有效性。方法 60例STEMI患者,随机分为比伐芦定组(30例)和普通肝素组(30例),比伐芦定组采用比伐芦定静脉注射,普通肝素组采用普通肝素。比较两组抗凝效果、PCI成功率、安全性(支架内血栓、出血不良反应发生率)。结果比伐芦定组和普通肝素组术中活化凝血时间(ACT)达标分别为29例(96.7%)和28例(93.3%),PCI成功率分别为28例(93.3%)和27例(90.0%),两组比较差异无统计学意义(P>0.05);总出血发生率分别为1例(3.3%)和8例(26.7%),两组比较差异具有统计学意义(P<0.05)。30 d内支架内血栓发生分别为0例和1例(3.3%),两组比较差异无统计学意义(P>0.05)。结论比伐芦定在STEMI患者行直接PCI术中的抗凝效果与普通肝素相当,降低了出血发生率,不增加支架内血栓的发生率。
Objective To compare the safety and efficacy of intravenous bivalirudin and unfractionated heparin in patients with acute ST-elevation myocardial infarction (STEMI) undergoing percutaneous coronary intervention (PCI). Methods Sixty STEMI patients were randomly divided into bivalirudin group (n = 30) and unfractionated heparin group (n = 30). Bivalirudin was injected intravenously with bivalirudin and unfractionated heparin was used in unfractionated heparin group. The anticoagulation effect, PCI success rate, safety (stent thrombosis, incidence of bleeding adverse reactions) in both groups were compared. Results The mean ACT achieved in the bivalirudin group and the unfractionated heparin group was 29 cases (96.7%) and 28 cases (93.3%), respectively. The PCI success rates were 28 cases (93.3%) and 27 cases 90.0%). There was no significant difference between the two groups (P> 0.05). The incidences of total bleeding were 1 case (3.3%) and 8 cases (26.7%) respectively. There was significant difference between the two groups ). Within 30 days, stent thrombosis occurred in 0 case and in 1 case (3.3%), respectively. There was no significant difference between the two groups (P> 0.05). Conclusion The anticoagulant effect of bivalirudin in patients with STEMI undergoing direct PCI is comparable to unfractionated heparin, reducing the incidence of bleeding and not increasing the incidence of stent thrombosis.