CAJ | 학술논문

目的观察比伐卢定对急诊PCI患者血浆CCL5、CCL18水平的影响，探讨比伐卢定在急诊PCI治疗中的作用及机制。方法选取2012年12月~2014年3月我院收治的150急诊PCI治疗的急性ST段抬高型心肌梗死患者，随机分为比伐卢定组(75例)和替罗非班加肝素组（75例）。所有患者在发病12 h内行急诊PCI术。比伐卢定组院在急诊PCI术前首先静脉给予比伐卢定负荷量（0.75 mg/kg）,然后，以1.75 mg/（kg·h）持续静脉点滴在PCI过程中。替罗非班加肝素组院术前静脉内注入10μg/kg替罗非班，然后以0.075μg/（kg·min）持续静脉滴注36 h,同时静脉内注入普通肝素100 U/kg。检测两组患者术前和术后的CCL5、CCL18浓度，并进行对比分析。结果和术前比较，术后24h两组患者血清中CCL5、CCL18浓度均有不同程度的降低，差异具有统计学意义（约0.05）；比伐卢定组患者术后CCL5、CCL18浓度均低于替罗非班加肝素组，差异具有统计学意义（约0.05）。术后比伐卢定组和替罗非班加肝素组穿刺部位出血并发症发生率（分别为4.0%和10.67%）差异具有统计学意义(约0.05)。结论比伐卢定可通过减低急诊PCI患者血浆CCL5、CCL18水平，改善患者预后并降低穿刺部位出血并发症。
목적관찰비벌로정대급진PCI환자혈장CCL5、CCL18수평적영향，탐토비벌로정재급진PCI치료중적작용급궤제。방법선취2012년12월~2014년3월아원수치적150급진PCI치료적급성ST단태고형심기경사환자，수궤분위비벌로정조(75례)화체라비반가간소조（75례）。소유환자재발병12 h내행급진PCI술。비벌로정조원재급진PCI술전수선정맥급여비벌로정부하량（0.75 mg/kg）,연후，이1.75 mg/（kg·h）지속정맥점적재PCI과정중。체라비반가간소조원술전정맥내주입10μg/kg체라비반，연후이0.075μg/（kg·min）지속정맥적주36 h,동시정맥내주입보통간소100 U/kg。검측량조환자술전화술후적CCL5、CCL18농도，병진행대비분석。결과화술전비교，술후24h량조환자혈청중CCL5、CCL18농도균유불동정도적강저，차이구유통계학의의（약0.05）；비벌로정조환자술후CCL5、CCL18농도균저우체라비반가간소조，차이구유통계학의의（약0.05）。술후비벌로정조화체라비반가간소조천자부위출혈병발증발생솔（분별위4.0%화10.67%）차이구유통계학의의(약0.05)。결론비벌로정가통과감저급진PCI환자혈장CCL5、CCL18수평，개선환자예후병강저천자부위출혈병발증。
Objective To observe the bivalirudin effect on plasma CCL5, CCL18 levels in patients with emergency percutaneous coronary intervention ( PCI), and to investigate the ef ect and mechanism of bivalirudin in the emergency treatment of PCI. Methods Choose patients with acute ST March in our hospital 150 emergency treatment of PCI segment elevation myocardial infarction during the period of December 2012 to March 2014, randomly divided into bivalirudin group (75 cases) and for non Luo Banga heparin group (75 cases). Al patients in the incidence of 12 hour experted emergency PCI. Operation.bivalirudin group: First, the patients were designed to receive 0.75mg/kg of bivalirudin as loading dose before PCI,and then, at 1.75 mg/ (kg o h) continuous infusion in the PCI process. For Luo non Banga heparin group:preoperative intravenous injection of 10μg/kg for Luo non class, then in 0.075μg/(kg o min) continuous infusion of 36 hours, at the same time intravenous heparin 100 U/kg. Detected the concentration of CCL5 and CCL18 of two groups of patients before and after PCI, and carried on the contrast analysis. Results Compared with preoperative, reducing 24 hours two group, the concentration of CCL18 in serum of patients with CCL5 had dif erent degree after operation, the dif erence was statistical y significant ( <0.05); Bivalirudin group of patients after CCL5, CCL18 concentrations were lower than for non Luo Banga heparin group, the dif erences were statistical y significant ( <0.05). Postoperative bivalirudin group and for non Luo Banga heparin group, the dif erence of the incidence of bleeding complications (respectively 4% and 10.67%) was statistical y significant ( < 0.05). Conclusion Bivalirudin can reduce CCL5, CCL18 level in plasma of patients with emergency PCI, thereby improve the prognosis and reduce bleeding complication.