CAJ | 학술논문

目的观察新药比伐芦定用于急性心肌梗死急诊介入术患者的临床疗效及安全性.方法将120名急诊心肌梗死后冠状动脉介入术(PCI)患者随机分为治疗组与对照组,各60例.治疗组患者于术前给予比伐芦定0. 75 mg/kg静脉注射,手术开始后给予1. 75 mg/(kg·h)持续输注至手术结束,至少维持30 min.对照组患者术前给予普通肝素60 U/kg静脉注射.治疗结束后观察并记录术前、术后心肌梗死溶栓治疗(TIMI)血流分级,术后24 h及1周后ST段回落情况及手术中的不良反应,并记录住院期间肌酸激酶峰值,及手术1周后左心室射血分数( LVEF ).结果治疗后,两组患者血流情况均有改善,2级和3级患者增加,0级和1级患者消失( P<0. 05);与治疗前比较,两组ST段回落情况均有改善,完全回落和部分回落患者明显增加,无回落患者明显减少( P<0. 05);同时,术后治疗组ST段回落情况明显好于对照组,完全回落和部分回落患者明显高于对照组,无回落患者明显少于对照组( P<0. 05);治疗后,两组患者LVEF较治疗前均显著提高( P<0. 05),治疗组患者LVEF明显高于对照组( P<0. 05);两组患者不良反应比较,治疗组患者恶心、头痛等症状与对照组相当,差异无统计学意义( P>0. 05 );严重出血明显低于对照组( P<0. 05).结论在介入术围术期应用比伐芦定可改善患者手术后心脏供血的功能,提高患者术后LVEF,促进了ST段回落,降低肌酸激酶,减少不良反应发生率,降低严重出血事件的发生,疗效好,安全性佳,值得推广.
목적 관찰신약비벌호정용우급성심기경사급진개입술환자적림상료효급안전성.방법 장120명급진심기경사후관상동맥개입술(PCI)환자수궤분위치료조여대조조,각60례.치료조환자우술전급여비벌호정0. 75 mg/kg정맥주사,수술개시후급여1. 75 mg/(kg·h)지속수주지수술결속,지소유지30 min.대조조환자술전급여보통간소60 U/kg정맥주사.치료결속후관찰병기록술전、술후심기경사용전치료(TIMI)혈류분급,술후24 h급1주후ST단회락정황급수술중적불량반응,병기록주원기간기산격매봉치,급수술1주후좌심실사혈분수( LVEF ).결과 치료후,량조환자혈류정황균유개선,2급화3급환자증가,0급화1급환자소실( P<0. 05);여치료전비교,량조ST단회락정황균유개선,완전회락화부분회락환자명현증가,무회락환자명현감소( P<0. 05);동시,술후치료조ST단회락정황명현호우대조조,완전회락화부분회락환자명현고우대조조,무회락환자명현소우대조조( P<0. 05);치료후,량조환자LVEF교치료전균현저제고( P<0. 05),치료조환자LVEF명현고우대조조( P<0. 05);량조환자불량반응비교,치료조환자악심、두통등증상여대조조상당,차이무통계학의의( P>0. 05 );엄중출혈명현저우대조조( P<0. 05).결론 재개입술위술기응용비벌호정가개선환자수술후심장공혈적공능,제고환자술후LVEF,촉진료ST단회락,강저기산격매,감소불량반응발생솔,강저엄중출혈사건적발생,료효호,안전성가,치득추엄.
Objective To evaluate the efficacy of bivalirudin in treating acute myocardial infarction ( AMI ) with patients who underwent emergency Percutaneous Coronary Intervention ( PCI ) . Methods 120 AMI patients had symptoms and received emergency PCI were di-vided into the treatment group and the control group, 60 cases in each group. The treatment group had bivalirudin 0. 75 mg/kg before PCI, and 1. 75 mg/ ( kg·h ) infusion until the end of surgery, maintaining at least 30 min;the control group received heparin 60 U/kg before PCI. After treatment, the assessment of the TIMI blood flow and ST-segment resolution was made, and the adverse reactions were recorded. Results After treatment, the blood flows of two groups were improved, with increase of Level 2, 3 patients, and disappearance of Level 0, 1 patients ( P < 0. 05 ); compared with before treatment, ST resolution in both groups were improved, with increase of fully and partially falling, and significant decrease of no-dropping ( P < 0. 05 );at the same time, the falling of ST resolution in the treatment group was significantly better than the control group, with increase of fully and partially falling more than the control group, and de-crease of no-dropping fewer than the control group ( P < 0. 05 );after treatment, the left ventricular ejection fraction of the two groups were significantly increased than before treatment ( P < 0. 05 ) , and the the increase in the treatment group was higher ( P < 0. 05 );the adverse reactions such as nausea, headache and other symptoms of the treatment group were similar with the control group ( P > 0. 05 ) , but the case of serious bleeding was less than the control group ( P < 0. 05 ) . Conclusion Bivalirudin is an effective medicine to pa-tients with acute myocardial infarction, which could improve the blood supply to the heart function after surgery, improve postoperative left ventricular ejection fraction, promote ST resolution, and reduce creatine kinase and the incidence of adverse reactions as well as the incidence of serious bleeding events. It has good clinical effect, good security, and is worthy of clinical promotion.