国产比伐卢定对急性冠状动脉综合征患者介入术中凝血功能的影响

目的:探讨国产注射用比伐卢定和普通肝素在急性冠状动脉综合征患者冠状动脉介入术中对凝血功能的影响。方法:入选95例择期行PCI的急性冠状动脉综合征患者,随机分为肝素组(n=49)和比伐卢定组(n=46),其中肝素组脱落3例,比伐卢定组脱落5例,比伐卢定组和肝素组各剔除6例。根据分组不同术中分别采用国产注射用比伐卢定或肝素抗凝。分别在用药前、用药后5 min、首次用药后30 min、停药后1 h及6 h检测活化凝血时间(ACT)。比较首次给药5min后和30min后的ACT达标率。结果:2组患者基线资料具有可比性,术前凝血指标差异无统计学意义(P>0.05),比伐卢定组和肝素组用药后ACT值迅速升高,2组5min和30minACT达标率相当,差异无统计学意义(P>0.05)。用药结束后比伐卢定组ACT值下降迅速,用药结束后1hACT值较肝素组显著降低,2组之间差异有统计学意义(P<0.05)。用药结束后6 h,2组ACT值下降至与基线相当,2组之间差异无统计学意义(P>0.05)。肝素组用药后5 min、30 min和1 h,ACT值的标准差均大于比伐卢定组。结论:与常规肝素抗凝相比,比伐卢定在PCI术中可以获得更稳定的抗凝效果,其作为抗凝剂用于PCI术中安全有效。

The Effects of domestic bivalirudin on coagulationduring percutaneous coronary intervention in acute coronary syndrome patients

Objective:To explore the effects of Bivalirudin on blood clotting of acute coronary syndrome(ACS) patients who received percutaneous coronary intervention(PCI),comparing with unfractionated heparin(UFH).Methods: A total of 95 ACS patients receiving PCI were included and randomized into UFH group(n=49) and Bivalirudin group(n=46).There were 3 and 5 missing patients in group UFH and Bivalirudin,respectively,then there 6 patients were excluded out of the analysis in each group.The blood clotting related parameters,including PT,APTT,and ACT,were detected before administration,5 min post-administration,30 min after the first dosage,1 h and 6 h after stopping infusion.Then the comparison of the above parameters and the rate of getting to the target were analyzed between the two groups.Results: The baseline data of the two groups were not significantly different(P>0.05).After administration,ACT was elevated very quickly in both groups,the rates of getting to the target at 5 min and 30 min post administration were not remarkable different between the two groups(P>0.05).At 1 h after administration,ACT was decreased rapidly,which was significantly lower than UFH group(P<0.05).At 6 h after stopping infusion,ACT was not significantly different between the two groups(P>0.05).In addition,the standard errors of all time-point ACT in UFH group were higher than Bivalirudin group.Conclusion: Compared with UFH group,the more stable anti-coagulation effects can be obtained by using Bivalirudin which is safe in PCI procedures.