老不稳定型心绞痛患者介入治疗中比伐卢定的安全性及有效性.docVIP

·基础研究· 老年不稳定型心绞痛患者介入治疗中比伐卢定的安全性及有效性 石燕昆, 杨丽霞*, 齐 峰, 樊 君, 保春萍, 张 维, 郭瑞威 （成都军区昆明总医院心血管内科, 昆明 650032） 【摘 要】目的 探讨老年不稳定型心绞痛患者择期行经皮冠状动脉介入治疗（PCI）时应用比伐卢定的有效性与安全性。方法 2010年11月至2013年3月拟择期行PCI治疗的60～75岁老年不稳定型心绞痛患者90例。比伐卢定组（47例）PCI术前静脉注射比伐卢定0.75mg/kg作为负荷剂量，5min后检测活化凝血时间（ACT），若ACT小于225s，再静脉注射比伐卢定0.3mg/kg，术中静脉滴注1.75mg/（kg·h）至手术结束。普通肝素组（43例）术前静脉注射普通肝素钠100U/kg，5min后检测ACT，若ACT小于225s，再静脉注射肝素钠3000U（若1h后手术仍未结束，再静脉注射肝素钠1000U）。主要安全性及有效性指标为两组患者PCI术后30d内出血事件发生率、MACE发生率及术中使用的ACT达标情况监测。结果 比伐卢定组与普通肝素组比较，PCI术后30d内出血率与MACE事件发生率差异无统计学意义（P＞Safety and efficiency of bivalirudin for senile unstable angina patients during percutaneous coronary intervention SHI Yankun, YANG Lixia, QI Feng, FAN Jun, BAO Chunping, ZHANG Wei, GUO Ruiwei (Department of Cardiology, Kunming General Hospital of Chengdu Military Command, Kunming 600032, China) 【Abstract】 Objective To evaluate the efficacy and safety of bivalirudin in selective percutaneous coronary intervention (PCI) in senile patients with unstable angina. Methods A total of 90 senile unstable angina patients with an age ranging from 60 to 75 who receiving PCI in our hospital from Nov. 2010 to Mar. 2013 were enrolled in this study. They were prospectively divided to 3 matched groups, that is, bivalirudin group (n＝47) eparin sodium group (control, n＝43were designed to receive bivalirudin of 0.75 mg/kg as loading dose before PCI, then followed by another injection of 0.3 mg/kg if accelerated clotting time (ACT) shorter than 225 s in 5 min later, and an intravenous injection of 1.75 mg/(kg?h) till the end of operation. While, the patients from another group had heparin sodium of 100 U/kg instead of bivalirudin, then another injection of 3000 U for shorter ACT, and the other injection of 1000 U if the operation did not end within 1 h. The safety and efficacy outcome were evaluated by bleeding events and major adverse cardiac events (MACE) in 30 d after PCI and ACT during PCI. Results There was no significant difference in the bleeding events and MACE in