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目的比较国产比伐卢定联合普通肝素、血小板糖蛋白Ⅱb/Ⅲa受体拮抗剂——替罗非班在急性非ST段抬高型心肌梗死(non-ST-segment elevation myocardial infarction,NSTEMI)患者行急诊经皮冠状动脉腔内血管成形术(percutaneous transluminal coronary angioplasty,PTCA)术前的应用效果。方法将121例急性NSTEMI患者按治疗方法的不同分为2组:比伐卢定(A)组61例,在急诊PTCA术前给予注射用比伐卢定0.75mg·kg-1静脉注射,再以1.75mg·kg-1·h-1静脉泵泵注,术后不给予低分子肝素治疗;肝素联合替罗非班(B)组60例,在急诊PTCA术前给予注射用盐酸替罗非班10μg·kg-1静脉注射,再以0.075μg·kg-1·min-1静脉泵泵注,同时给予普通肝素100U·kg-1静脉注射,术后给予低分子肝素治疗。观察2组冠状动脉病变(单支病变、双支病变、三支病变、左主干病变、≥90%的狭窄、100%的闭塞、扩张性病变及2级以上侧支循环)及住院时间、并发症(心力衰竭、轻度出血)发生率。结果 2组单支病变、双支病变、三支病变、左主干病变、≥90%的狭窄、100%的闭塞、扩张性病变及2级以上侧支循环所占比例和并发症发生率比较差异无统计学意义(P>0.05)。A组住院时间较B组短(P<0.05)。术后随访30d,2组均无死亡、支架内血栓及再发心肌梗死。结论对急性NSTEMI患者在急诊PTCA术前应用国产比伐卢定可获得较好的抗凝效果,具有良好的安全性。
Objective To compare the effects of domestic bivalirudin combined with unfractionated heparin and platelet glycoprotein Ⅱb / Ⅲa receptor antagonist-tirofiban in patients with acute non-ST-segment elevation myocardial infarction (NSTEMI) Preoperative emergency percutaneous transluminal coronary angioplasty (percutaneous transluminal coronary angioplasty, PTCA) preoperative application effect. Methods A total of 121 patients with acute NSTEMI were divided into two groups according to the different treatment methods: 61 patients received bivalirudin (A), and received intravenous injection of bivalirudin 0.75 mg · kg -1 before emergency PTCA The rats were injected with 1.75 mg · kg-1 · h-1 intravenous pump and no low-molecular-weight heparin was given postoperatively. Sixty patients treated with heparin combined with tirofiban (group B) were given tirofiban The rats were injected intravenously with 10μg · kg-1 Baixin injection and then with 0.075μg · kg-1 · min-1 intravenous infusion. Meanwhile, unfractionated heparin (100U · kg-1) was given intravenously. Low molecular weight heparin was given after operation. Two groups of coronary artery disease (single vessel disease, double vessel disease, triple vessel disease, left main vessel disease, ≥90% stenosis, 100% occlusion, dilatation lesion and grade 2 or more collateral circulation) and hospitalization were observed. Symptoms (heart failure, mild bleeding) incidence. Results There were significant differences between the two groups in the incidence of single vessel lesion, double vessel lesion, three vessel lesion, left main vessel lesion, ≥90% stenosis, 100% occlusion, dilatation lesion and the grade 2 collateral circulation and complication rate No statistical significance (P> 0.05). The hospitalization time in group A was shorter than that in group B (P <0.05). After 30 days of follow-up, no deaths, no stent thrombosis and recurrent myocardial infarction occurred in both groups. Conclusion The application of domestic bivalirudin before emergency PTCA in patients with acute NSTEMI can achieve good anticoagulant effect and has good safety.