围术期肠外抗凝辅助PCI术对急性冠脉综合征救治情况及预后的影响

Impact of perioperative extracorporeal anticoagulation assisted PCI on treatment and prognosis of acute coronary syndrome

摘要:

目的 观察围术期肠外抗凝（PACT）辅助经皮冠脉介入术（PCI）对急性冠脉综合征（ACS）救治情况及预后的影响。方法 该文为前瞻性研究，病例纳入南阳市第一人民医院2021年6月至2022年12月收治的120例ACS患者，采用随机数字表法将入组患者分为联合组（60例）和常规组（60例）。常规组术前予以普通肝素治疗辅助PCI，联合组术前采用普通肝素+术中采用比伐卢定抗凝治疗辅助PCI。两组术后均短期随访1个月，比较两组患者的救治情况及预后情况。结果 入院时，两组患者的凝血功能差异无统计学意义（P>0.05）；联合组术后8 h内的活化部分凝血活酶时间（APTT）、凝血酶原时间（PT）、凝血酶时间（TT）分别为（33.25±5.32）s、（13.49±3.27）s、（27.11±5.26）s，均高于常规组［（30.42±5.24）s、（11.25±3.16）s、（24.12±5.31）s］（P<0.05）。入院时，两组患者的心肌损伤标志物水平差异无统计学意义（P>0.05）；联合组术后8 h内的肌酸激酶同工酶（CK-MB）、心肌肌钙蛋白Ⅰ（cTnⅠ）、乳酸脱氢酶（LDH）分别为（7.25±1.33）U/L、（0.45±0.21）ng/mL、（122.45±20.75）U/L，均低于常规组［（8.33±2.01）U/L、（0.82±0.31）ng/mL、（140.74±20.18）U/L］（P<0.05）。入院时，两组患者的心功能指标差异无统计学意义（P>0.05）；联合组术后8 h内的左室射血分数（LVEF）为（56.33±10.27）%，高于常规组［（50.45±10.32）%］，左室舒张末期内径（LVDD）为（37.25±5.44）mm，低于常规组［（40.18±5.26）mm］（P<0.05）。随访期间，联合组的主要心血管不良事件（MACE）发生率为8.33%（5/60），低于常规组［21.67%（13/60）］（P<0.05）；联合组的药物相关副反应发生率为11.67%（7/60），略高于常规组［10.00%（6/60）］（P>0.05）。结论 围术期PACT能一定程度上延长ACS患者的凝血时间，并减轻心肌损伤，对促进患者心功能恢复、增强急诊救治效果，并降低术后MACE发生风险有积极作用。围术期PACT未明显增加药物副反应发生风险，具有一定推广价值。

Abstract:

Objective To observe the impact of perioperative PACT assisted PCI on the treatment and prognosis of ACS.Methods This article is a prospective study, with cases included from June 2021 to December 2022. The study subjects were 120 patients with ACS. The enrolled patients were randomly divided into a combination group (60 cases) and a conventional group (60 cases) using a random number table method. The conventional group received preoperative treatment with ordinary heparin as an adjuvant PCI, while the combination group received preoperative treatment with ordinary heparin and intraoperative anticoagulant therapy with bivalirudin as an adjuvant PCI. Both groups were followed up for a short period of 1 month after surgery. The treatment and prognosis of two groups of patients were compared.Results At admission, the coagulation function of the two groups of patients was similar (P>0.05). The APTT, PT, and TT within 8 hours after surgery in the combination group were 33.25±5.32 s, 13.49±3.27 s, and 27.11±5.26 s, respectively, which were higher than those in the conventional group (30.42±5.24 s, 11.25±3.16 s, and 24.12±5.31 s) (P<0.05). At admission, the levels of myocardial injury markers in both groups of patients were similar (P>0.05). Within 8 hours after surgery, the CK-MB, cTnI, and LDH levels in the combination group were 7.25±1.33 U/L, 0.45±0.21 ng/mL, and 122.45±20.75 U/L, respectively, lower than those in the conventional group (8.33±2.01 U/L, 0.82±0.31 ng/mL, and 140.74±20.18 U/L) (P<0.05). At admission, the cardiac function indicators of the two groups of patients were similar (P>0.05). The LVEF within 8 hours after surgery in the combination group were 56.33%±10.27%, higher than that in the conventional group (50.45%±10.32%). The LVDD was 37.25±5.44 mm, lower than the conventional group (40.18±5.26 mm) (P<0.05). During the follow-up period, the incidence of MACE in the combination group was 8.33% (5/60), lower than 21.67% (13/60) in the conventional group (P<0.05). The incidence of drug-related side effects in the combination group was 11.67% (7/60), slightly higher than that in the conventional group [10.00% (6/60)] (P>0.05).Conclusion Perioperative PACT can prolong the clotting time of ACS patients to a certain extent, reduce myocardial damage, promote the recovery of patients' cardiac function, enhance the effectiveness of emergency treatment, and reduce the risk of postoperative MACE. Perioperative PACT did not significantly increase the risk of drug side effects and has certain promotional value.