优化比伐芦定抗凝方案应用于...经皮冠状动脉介入的临床疗效_包恩泽.pdf

论著 503中国医刊 2023 年 第58卷 第5期12 LI H,QIN S,LIANG Q,et al.Exercise training enhances myocardial mitophagy and improves cardiac function via Irisin/FNDC5-PINK1/Parkin pathway in MI miceJ.Biomedicines,2021,9(6):701.13 SANCHIS-GOMAR F,LAVIE C J,MARN J,et al.Exercise effects on cardiovascular disease:from basic aspects to clinical evidenceJ.Cardiovasc Res,2022,118(10):2253-2266.14 KOH K W,WANG W,RICHARDS A M,et al.Effectiveness of advanced practice nurse-led telehealth on readmissions and health-related outcomes among patients with post-acute myocardial infarction:ALTRA Study ProtocolJ.J Adv Nurs,2016,72(6):1357-1367.15 梁鹏,张明明,高蕾,等.家庭运动康复模式对经皮冠状动脉介入治疗术后患者焦虑抑郁状态的影响J.中国医刊,2021,56(8):853-856.16 GUAZZI M,BANDERA F,OZEMEK C,et al.Cardiopulmonary exercise testing:What is its value?J.J Am Coll Cardiol,2017,70(13):16-18.17 KETEYIAN S J,BRAWNER C A,SAVAGE P D,et al.Peak aerobic capacity predicts prognosis in patients with coronary heart diseaseJ.Am Heart J,2008,156(2):292-300.18 SNOEK J A,PRESCOTT E I,VAN DER VELDE A E,et al.Effectiveness of home-based mobile guided cardiac rehabilitation as alternative strategy for nonparticipation in clinic-based cardiac rehabilitation among elderly patients in Europe:A randomized clinical trialJ.JAMA Cardiol,2021,6(4):463-468.19 DORJE T,ZHAO G,SCHEER A,et al.SMART phone and social media-based Cardiac Rehabilitation and Secondary Prevention(SMART-CR/SP)for patients with coronary heart disease in China:a randomised controlled trial protocolJ.BMJ Open,2018,8(6):e021908.20 王隽,李刚,王沅,等.新冠肺炎疫情下互联网医院建设探讨J.中国社会医学杂志,2022,39(1):4-6.（收稿日期：2023-01-30；修回日期：2023-03-15）（本文编辑：安静）优化比伐芦定抗凝方案应用于老年急性心肌梗死 急诊经皮冠状动脉介入的临床疗效包恩泽，皮林*，贾衍尧，徐世莹，周立辉，齐冰洋（北京市垂杨柳医院 心内科，北京 100022）摘要：目的分析老年急性心肌梗死患者行急诊经皮冠状动脉介入时应用优化比伐芦定抗凝方案的临床疗效及安全性。方法选 择2020年8月至2021年8月在北京市垂杨柳医院行急诊经皮冠状动脉介入治疗的老年急性心肌梗死患者84例，采用随机数字表法分为普通肝素组和优化比伐芦定组，每组42例。普通肝素组围术期予以普通肝素抗凝方案，优化比伐芦定组予以优化比伐芦定抗凝方案，比较两组凝血功能、主要终点事件及次要终点事件的差异。结果两组术前、术后24h的活化部分凝血活酶时间、纤维蛋白原、凝血酶时间、凝血酶原时间差异无显著性（P0.05）。两组院内及出院后30d主要心血管不良事件发生率比较差异无显著性（P0.05）。优化比伐芦定组院内及出院后30d的出血事件发生率低于普通肝素组，差异有显著性（P0.05）。结论老 年急性心肌梗死患者急诊经皮冠状动脉介入治疗中，应用普通肝素与优化比伐芦定抗凝方案均可有效预防术后主要心血管不良事件的发生，但优化比伐芦定抗凝方案出血事件发生率更低，安全性更好。关键词：普通肝素；比伐芦定；抗凝；老年急性心肌梗死；介入；辅助治疗中图分类号：R543.3+1文献标识码：A文章编号：1008-1070（2023）05-0503-04doi:10.3969/j.issn.1008-1070.2023.05.010Clinical effectiveness of optimized protocol for anticoagulation with bivalradine in the interventional adjuvant therapy of elderly patients with acute myocardial infarctionBao Enze,Pi Lin*,Jia Yanyao,Xu Shiying,Zhou Lihui,Qi Bingyang(Department of Cardiology,Beijing Chuiyangliu Hospital,Beijing 100022,China)*Corresponding author,E-mail:Abstract:Objective To compare the clinical efficacy and safety of unfractionated heparin and optimized protocol for anticoagulation with bivalradine in emergency intervention of elderly patients with acute myocardial infarction.Method 84 cases of elderly patients with acute myocardial infarction who were underwent interventional therapy in Beijing Chuiyangliu Hospital from August 2020 to August 2021 were selected.According to the random number table method,they were divided into unfractionated heparin group and bivalirudin group,with 42 cases in each group.42 patients in the unfractionated heparin group were anticoagulated with unfractionated heparin,and 42 patients in the bivalirudin group were anticoagulated with bivalirudin to optimize the anticoagulation intensity after surgery,comparative analysis of coagulation function,primary end point events and secondary end point events between the two groups.Result The thromboplastin time(APTT),fibrinogen(FIB),plasma thrombin time(TT),prothrombin time(PT)before and 24h after operation were compared between the two groups,the difference was not statistically significant(P 0.05).There was no significant difference in the incidence of net clinical adverse events(MACE)between the two groups in hospital and 30 days after operation(P0.05).The bleeding rate in hospital and 30 days after operation in bivalirudin group was lower than that in unfractionated heparin group(P0.05).Conclusion In the emergency interventional treatment of elderly patients with acute myocardial infarction,the efficacy of unfractionated heparin and optimized protocol for anticoagulation with bivalradine is equivalent,which can effectively prevent the occurrence of adverse cardiovascular events after surgery,but the optimized protocol for anticoagulation with bivalradine has fewer bleeding events and more ideal safety.Keywords:Unfractionated heparin;Bivalrudine;Anticoagulation;Elderly acute myocardial infarction;Intervention;Adjuvant therapy*通信作者，E-mail:504 论著 中国医刊 2023 年 第58卷 第5期急性心肌梗死在急性心血管疾病中较为常见，主要引发原因为冠状动脉血液供应急剧减少或中断，病情紧急且凶险，需及时对堵塞的冠状动脉进行再通1。经皮冠状动脉介入为其常用的治疗方式，可快速疏通、扩大闭塞血管的局部管腔，促进心肌供血恢复，但手术获益情况在很大程度上与围术期抗凝治疗的效果有关2。以往临床上广泛选择普通肝素抗凝，可通过间接抑制凝血酶活性达到抗凝效果，但存在出血、肝素诱导血小板减少症等风险3。比伐芦定为直接凝血酶抑制剂，可通过直接对凝血酶a因子的活性产生抑制作用，且清除途径有肾脏代谢、蛋白水解两种，抗原性较弱，出血发生风险较低4。近年来，比伐芦定已被广泛应用于急诊介入手术中，但使用方法一般为低剂量维持或高剂量维持，本院将优化比伐芦定应用于老年急性心肌梗死患者急诊经皮冠状动脉介入时，通过优化抗凝强度，提高了药物的有效性与安全性，现报道如下。1资料与方法 1.1