目的：观察急诊经皮冠状动脉介入术（PCI）围术期比伐芦定联合替格瑞洛抗栓治疗的出血风险。方法回顾性分析该院收治的急性ST段抬高型心肌梗死（STEMI）并成功完成急诊PCI术的患者458例，依据PCI术中使用的抗凝方案将其分为比伐芦定组（217例）与普通肝素组（241例），所有患者术前均给予替格瑞洛180 mg、阿司匹林100 mg双联抗血小板治疗，并在术后长期给予替格瑞洛90 mg （每日2次）、阿司匹林100 mg （每日1次），分析患者临床资料，比较两组 PCI术后72 h的出血情况。结果两组患者性别、年龄、体质量、吸烟者所占百分比、伴随疾病及并发症的发生率，以及 PCI术前红细胞计数、血小板计数、血红蛋白含量、凝血酶原时间比较，差异均无统计学意义（P＞0．05）。比伐芦定组出血发生率低于普通肝素组，差异有统计学意义（χ2＝8．455，P＝0．05）。结论与普通肝素相比，在应用替格瑞洛的基础上PCI术中给予比伐芦定抗凝可减少患者的出血风险。%Objective To observe the bleeding risk of bivalirudin combined with ticagrelor in patients with acute ST segment elevation myocardial infarction (STEMI) during emergency percutaneous coronary intervention (PCI) .Methods A retrospective a‐nalysis of 458 patients with STEMI who underwent emergency PCI in our hospital was performed .All patients were divided into the bivalirudin group (217 cases) and the standard heparin group(241 cases) according to the anticoagulation scheme during PCI opera‐tion .All patients administered the dual antiplatelet therapy of aspirin 100 mg and ticagrelor 180 mg before surgery .Then ,all pa‐tients were administered dual antiplatelet therapy of aspirin 100 mg once daily and ticagrelor 90 mg twice daily for a long time .The clinical data were analyzed and the bleeding situation within 72 h after PCI was compared between the two groups .Results There were no statistically significant differences in gender ,age ,body mass ,smoking proportion ,occurrence rates of accompanying and complicating diseases ,RBC count ,platelet count ,Hb and PT before PCI between the two groups(P>0 .05) .The bleeding incidence rate in the bivalirudin group was significantly lower than that in the standard heparin group ,and the difference was statistically sig‐nificant (χ2 =8 .455 ,P<0 .05) .Conclusion Compared with standard heparin ,on the basis of ticagrelor use ,giving bivalirudin dur‐ing PCI process can reduce the bleeding risk of patients .
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