本文選題：比伐蘆定　切入點(diǎn)：腎功能不全　出處：《青島大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：目的通過觀察應(yīng)用國(guó)產(chǎn)比伐蘆定對(duì)冠心病合并腎功能不全患者行經(jīng)皮冠狀動(dòng)脈介入術(shù)(PCI)后激活凝血時(shí)間(ACT)、凝血酶時(shí)間(TT)、活化部分凝血酶時(shí)間(APTT)、凝血酶原時(shí)間(PT)、纖維蛋白原(FIB)變化及30d主要不良心腦血管事件(MACCE)、術(shù)后出血并發(fā)癥以及急性和亞急性支架血栓事件的發(fā)生情況,探討此類患者使用國(guó)產(chǎn)比伐蘆定的療效性及安全性,以及合并另一獨(dú)立危險(xiǎn)因素女性患者應(yīng)用國(guó)產(chǎn)比伐蘆定的療效性及安全性。方法隨機(jī)選擇2015年10月至2016年08月入住我院的冠狀動(dòng)脈粥樣硬化性心臟病合并腎功能不全的PCI患者,按隨機(jī)雙盲法分為肝素組和國(guó)產(chǎn)比伐蘆定組進(jìn)行抗凝,亞組女性患者根據(jù)所用抗凝藥物不同,分為肝素組和比伐蘆定組。分別于PCI術(shù)前、應(yīng)用抗凝藥后5min、術(shù)后即刻、停藥后30min、停藥后1小時(shí)、停藥后2小時(shí)測(cè)定ACT值;應(yīng)用抗凝藥前、用藥結(jié)束后6、24和72h測(cè)定APTT、TT、PT、FIB;分別在用抗凝藥前、用藥結(jié)束后24h測(cè)定血小板計(jì)數(shù)(PLT)。通過門診或電話隨訪30d主要不良心腦血管事件(MACCE)、術(shù)后出血并發(fā)癥以及支架血栓事件的發(fā)生情況。結(jié)果(1)比伐蘆定組與肝素組相比,用藥后5分鐘,手術(shù)結(jié)束后立即測(cè)定ACT,比伐蘆定組明顯大于肝素組(P0.05),停藥后1小時(shí)、2小時(shí)測(cè)定ACT值,比伐蘆定組明顯小于肝素組(P0.05);術(shù)后兩組血小板及術(shù)后凝血功能相比無統(tǒng)計(jì)學(xué)差異(P0.05)。比伐蘆定組與肝素組30天凈不良臨床事件差異有統(tǒng)計(jì)學(xué)意義(12.22%vs 26.38%,P0.025);30d主要不良心臟或腦事件沒有統(tǒng)計(jì)學(xué)差異(1.11%vs 2.20%,P0.05);30d全部出血比伐蘆定組相比肝素組顯著降低(11.11%vs24.18%,P0.05)。術(shù)后30d支架內(nèi)血栓形成無統(tǒng)計(jì)學(xué)差異。(2)而對(duì)于女性亞組結(jié)果為:比伐蘆定組在給藥后5min、術(shù)后立即ACT值明顯大于肝素組(P0.05);術(shù)前和停藥后30min,兩組患者相比ACT值差異無統(tǒng)計(jì)學(xué)意義(P0.05);停藥后1h、2h測(cè)定ACT值,比伐蘆定組顯著小于普通肝素組(P0.05);兩組術(shù)后凝血功能及血小板比較均無統(tǒng)計(jì)學(xué)差異(P0.05)。比伐蘆定組與肝素組30天凈不良臨床事件差異有統(tǒng)計(jì)學(xué)意義(21.88%vs 48.72%,P0.05);30d主要不良心臟或腦事件沒有統(tǒng)計(jì)學(xué)差異(0%vs 2.56%,P0.05);術(shù)后30d比伐蘆定組全部出血與肝素組相比顯著降低(21.88%vs 46.15%,P0.05);術(shù)后30d支架內(nèi)血栓形成無統(tǒng)計(jì)學(xué)差異。結(jié)論1、比伐蘆定相比肝素對(duì)冠心病合并腎功能不全行PCI術(shù)的患者抗凝治療中,起效更快,半衰期更短,能達(dá)到相同抗凝療效且安全性更好;2、此類患者合并另一獨(dú)立危險(xiǎn)因素女性時(shí),同樣能達(dá)到相同的抗栓療效,也可明顯減少出血不良事件,具有很好的抗凝療效及安全性。
[Abstract]:Objective To observe the application of domestic bivalirudin in patients with renal insufficiency undergoing percutaneous coronary intervention on coronary heart disease (PCI) after activated clotting time (ACT), thrombin time (TT), activated partial thromboplastin time (APTT), prothrombin time (PT), fibrinogen (FIB) and 30d change the main adverse cardiovascular events (MACCE), and the complications of acute and subacute stent thrombosis events of postoperative hemorrhage, discuss such patients to use domestic than the efficacy and safety of atorvastatin Luding, and combined with other independent risk factors of female patients with domestic than the efficacy and safety of the Luding method. Randomly selected from October 2015 to 2016 08 months in our hospital coronary atherosclerotic renal disease complicated with cardiac functional insufficiency of the PCI patients, randomly divided into heparin group and domestic bivalirudin anticoagulation group, subgroup of women 鑰呮牴鎹墍鐢ㄦ姉鍑濊嵂鐗╀笉鍚，

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