目的 探讨阿加曲班不同抗凝强度在高出血风险急性 ST 段抬高型心肌梗死（STEMI）患者 经皮冠状动脉介入术（PCI）中的疗效及安全性。方法 选取高出血风险 STEMI 并行 PCI 的患者 156 例，采用随机数字表法随机分为A组、B组和C组，各52例。在PCI中三组应用不同剂量的阿加曲班抗凝，分别维 持不同活化凝血时间（ACT）至术毕。PCI 术前及术毕即刻监测心肌梗死溶栓试验（TIMI）血流分级、TIMI 心肌灌注分级（TMPG）、校正 TIMI 血流计帧数（cTFC）；记录 PCI 术后 7 d 内的出血事件发生率；随访术 后 6 个月内的主要不良心血管事件（MACE）。结果 PCI 术毕即刻 B 组患者的心肌灌注指标（TIMI 血流分 级、TMPG 分级、cTFC 帧数）均优于 A 组（P = 0.012、0.006、0.005）；PCI 术后 7 d 内，B 组出血事件发生率低 于 C 组（P = 0.022）；PCI 术后 6 个月内，B 组 MACE 发生率低于 A 组（P = 0.038）。结论 在高出血风险 STEMI 患者行 PCI 中，B 组的心肌灌注水平优于 A 组，出血事件发生率低于 C 组，MACE 发生率低于 A 组，B 组维持 ACT（250 ~ 300）s 为较优抗凝方案。

Objective To investigate the efficacy and safety of different anticoagulation intensities of arg⁃ atroban in patients with acute ST⁃segment elevation myocardial infarction（STEMI）with high blood risk after percu⁃ taneous coronary intervention（PCI）. Methods A total of 156 patients with high blood risk STEMI and PCI，were randomly divided into group A，B and C with 52 cases each. The three groups were treated with different doses of agatroban anticoagulation in PCI，and different activated coagulation time（ACT）was maintained until after sur⁃ gery. Myocardial infarction thrombolysis test （TIMI） blood flow grading，TIMI myocardial perfusion grading （TMPG）and TIMI Hemometer frame calibration（cTFC）were monitored before and immediately after PCI. The incidence of bleeding events within 7 days after PCI was recorded and major adverse cardiac events（MACE）was followed up within 6 months. Results Myocardial perfusion indexes（TIMI grading，TMPG grading，cTFC frame number）in group B were superior to those in group A immediately after PCI（P = 0.012，0.006，0.005）. Within 7 days after PCI，the incidence of bleeding events in group B was lower than that in group C（P = 0.022）. The inci⁃ dence of MACE in group B was lower than that in group A within 6 months after PCI（P = 0.038）. Conclusion In PCI for STEMI patients with high blood risk，the myocardial perfusion level in group B is better than that in group A；the incidence of bleeding events is lower than that in group C，and the incidence of MACE is lower than that in group A. ACT（250 ~ 300）s is maintained as the optimal anticoagulation regimen in group B.