摘要：ABSTRACT:Objective To compare the efficacies of domestic bivalirudin and combined unfrac-tionated heparin and platelet glycoprotein Ⅱb/Ⅲa receptor antagonist triofiban in patients under-going percutaneous transluminal coronary angioplasty(PTCA)for acute non-ST-segment eleva-tion myocardial infarction (NSTEMI).Methods A total of 121 patients suffered from acute NSTEMI were divided into two groups.Patients in group A(n=61)were given intravenous injec-tion of bivalirudin(0.75 mg·kg-1 )before PTCA,followed by intravenous infusion of bivalirudin (1.75 mg·kg-1 )during PTCA,and did not receive low molecular weight heparin after PTCA. Patients in group B(n= 60)were given intravenous injection of tirofiban(10 μg· kg-1 )before PTCA,followed by intravenous infusion of tirofiban(0.075 μg·kg-1 )and intravenous injection of unfractionated heparin(100 U·kg-1 )during PTCA,and received low molecular weight hepa-rin after PTCA.Coronary artery lesion characteristics (single-vessel disease,double-vessel dis-ease,triple-vessel disease,left main coronary disease,≥90% stenosis,100% occlusion,dilated le-sion,and more than 2 grade collateral circulation),length of hospital stay,and incidence of compli-cations(heart failure and mild bleeding)were observed in both groups.Results There were no significant differences in single-vessel disease,double-vessel disease,triple-vessel disease,left main coronary disease,≥90% stenosis,100% occlusion,dilated lesion,and more than 2 grade collateral circulation proportion and incidence of complications between the two groups(P > 0.05).The length of hospital stay in group A was shorter than that in group B(P <0.05).After 30 days of follow-up,no death,stent thrombosis and recurrent myocardial infarction were found in both groups.Conclusion Preoperative application of bivalirudin results in good anticoagulant efficacy and safety in patients undergoing PTCA for acute NSTEMI.%目的：比较国产比伐卢定联合普通肝素、血小板糖蛋白Ⅱb／Ⅲa 受体拮抗剂———替罗非班在急性非 ST 段抬高型心肌梗死（non-ST-segment elevation myocardial infarction，NSTEMI）患者行急诊经皮冠状动脉腔内血管成形术（percutaneous transluminal coronary angioplasty，PTCA）术前的应用效果。方法将121例急性 NSTEMI 患者按治疗方法的不同分为2组：比伐卢定（A）组61例，在急诊 PTCA 术前给予注射用比伐卢定0．75 mg·kg－1静脉注射，再以1．75 mg·kg－1·h－1静脉泵泵注，术后不给予低分子肝素治疗；肝素联合替罗非班（B）组60例，在急诊 PTCA 术前给予注射用盐酸替罗非班10μg·kg－1静脉注射，再以0．075μg·kg－1·min－1静脉泵泵注，同时给予普通肝素100 U·kg－1静脉注射，术后给予低分子肝素治疗。观察2组冠状动脉病变（单支病变、双支病变、三支病变、左主干病变、≥90％的狭窄、100％的闭塞、扩张性病变及2级以上侧支循环）及住院时间、并发症（心力衰竭、轻度出血）发生率。结果2组单支病变、双支病变、三支病变、左主干病变、≥90％的狭窄、100％的闭塞、扩张性病变及2级以上侧支循环所占比例和并发症发生率比较差异无统计学意义（P ＞0．05）。A 组住院时间较 B 组短（P ＜0．05）。术后随访30 d，2组均无死亡、支架内血栓及再发心肌梗死。结论对急性 NSTEMI 患者在急诊 PT-CA 术前应用国产比伐卢定可获得较好的抗凝效果，具有良好的安全性。
