摘要
目的探讨阿加曲班不同抗凝强度在高出血风险急性ST段抬高型心肌梗死(STEMI)患者经皮冠状动脉介入术(PCI)中的疗效及安全性。方法选取高出血风险STEMI并行PCI的患者156例,采用随机数字表法随机分为A组、B组和C组,各52例。在PCI中三组应用不同剂量的阿加曲班抗凝,分别维持不同活化凝血时间(ACT)至术毕。PCI术前及术毕即刻监测心肌梗死溶栓试验(TIMI)血流分级、TIMI心肌灌注分级(TMPG)、校正TIMI血流计帧数(cTFC);记录PCI术后7 d内的出血事件发生率;随访术后6个月内的主要不良心血管事件(MACE)。结果 PCI术毕即刻B组患者的心肌灌注指标(TIMI血流分级、TMPG分级、c TFC帧数)均优于A组(P=0.012、0.006、0.005);PCI术后7 d内,B组出血事件发生率低于C组(P=0.022);PCI术后6个月内,B组MACE发生率低于A组(P=0.038)。结论在高出血风险STEMI患者行PCI中,B组的心肌灌注水平优于A组,出血事件发生率低于C组,MACE发生率低于A组,B组维持ACT(250-300)s为较优抗凝方案。
Objective To investigate the efficacy and safety of different anticoagulation intensities of argatroban in patients with acute ST-segment elevation myocardial infarction(STEMI)with high blood risk after percutaneous coronary intervention(PCI). Methods A total of 156 patients with high blood risk STEMI and PCI,were randomly divided into group A,B and C with 52 cases each. The three groups were treated with different doses of agatroban anticoagulation in PCI,and different activated coagulation time(ACT)was maintained until after surgery. Myocardial infarction thrombolysis test(TIMI) blood flow grading,TIMI myocardial perfusion grading(TMPG)and TIMI Hemometer frame calibration(cTFC)were monitored before and immediately after PCI. The incidence of bleeding events within 7 days after PCI was recorded and major adverse cardiac events(MACE)was followed up within 6 months. Results Myocardial perfusion indexes(TIMI grading,TMPG grading,cTFC frame number)in group B were superior to those in group A immediately after PCI(P = 0.012,0.006,0.005). Within 7 days after PCI,the incidence of bleeding events in group B was lower than that in group C(P = 0.022). The incidence of MACE in group B was lower than that in group A within 6 months after PCI(P = 0.038). Conclusion In PCI for STEMI patients with high blood risk,the myocardial perfusion level in group B is better than that in group A;the incidence of bleeding events is lower than that in group C,and the incidence of MACE is lower than that in group A. ACT(250 - 300)s is maintained as the optimal anticoagulation regimen in group B.
作者
王中明
郑海军
曾辉
晋辉
刘静
韩风杰
邱翠婷
张建军
WANG Zhongming;ZHENG Haijun;ZENG Hui;JIN Hui;LIU Jing;HAN Fengjie;QIU Cuiting;ZHANG Jian-jun(Department of Cardiology,Jiaozuo People′s Hospital Affiliated to He′nan University,Jiaozuo 454002,China;不详)
出处
《实用医学杂志》
CAS
北大核心
2021年第23期3057-3061,共5页
The Journal of Practical Medicine
基金
北京市医院管理中心内科学科协同发展中心专项重点项目子课题(编号:XXZ0607)。
