黎婧怡,刘震宇,张抒扬,沈珠军,范中杰,曾勇,谢洪智,王崇慧,金晓峰,方全

• 1:中国医学科学院北京协和医学院北京协和医院心内科

摘要(Abstract)：

目的分析择期经皮冠状动脉介入治疗(percutaneous coronary intervention,PCI)患者使用普通肝素(unfractionated heparin,UFH)抗凝后活化凝血时间(activated clotting time,ACT)<300 s的预测因素。方法连续入选2011年5月1日至2012年12月31日在北京协和医院行择期PCI且术中使用UFH抗凝的患者,根据首次静脉注射UFH 5 min时的ACT水平将患者分为抗凝不足组(ACT<300 s)和对照组(ACT≥300 s),比较两组患者的临床和冠状动脉造影资料,分析抗凝强度不足的预测因素和预测界值。结果(1)共入选1062例患者,男752例(70.8%),女310例(29.2%),平均年龄(63.0±10.6)岁,平均体重(70.5±11.7)kg,UFH首次平均给药剂量(100.7±9.1)U/kg。(2)ACT均数为(299.1±82.9)s,中位数为285(240,352)s。其中,ACT<300 s的患者598例(56.3%),ACT为300~350 s的患者183例(17.2%),ACT≥350 s的患者281例(26.5%)。(3)与对照组相比,抗凝不足组的ACT[(242.3±33.9)s比(372.3±68.8)s,P<0.0001]、UFH剂量[(100.1±8.9)U/kg比(101.4±9.2)U/kg,P=0.03]和白蛋白水平[(39.7±4.2)g/L比(40.7±3.8)g/L,P=0.001]更低;而血小板计数[(219.6±62.5)×10~9/L比(208.9±66.7)×10~9/L,P=0.008]更高,差异均有统计学意义。(4)logistic回归分析显示,血清白蛋白水平(OR 0.940,95%CI 0.900~0.980,P<0.01)和血小板计数(OR 1.003,95%CI 1.001~1.006,P=0.01)是ACT<300 s的独立预测因素。(5)根据受试者工作特征曲线,血清白蛋白<42 g/L和血小板计数>215×109/L为预测ACT<300 s的最佳界值。结论择期PCI患者术中使用UFH后出现抗凝强度不足的比例较高,基线血清白蛋白和血小板计数是抗凝强度不足的独立预测因素。

关键词(KeyWords)： 经皮冠状动脉介入治疗;普通肝素;活化凝血时间;预测因素

Abstract:

Keywords:

基金项目(Foundation):

作者(Author): 黎婧怡,刘震宇,张抒扬,沈珠军,范中杰,曾勇,谢洪智,王崇慧,金晓峰,方全

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