论文部分内容阅读
目的探讨经皮冠状动脉介入(PCI)术前短期的高剂量阿托伐他汀的强化预处理对老年非ST段抬高型急性冠脉综合征(NSTEACS)患者PCI术中的心肌保护作用。方法92例住院准备PCI治疗的老年ACS患者随机分为强化组(PCI术前使用阿托伐他汀40mg/d预处理3～5d,共47例)和对照组(PCI术前仅使用阿托伐他汀10mg/d预处理3～5d,共45例),其余药物治疗两组类似,后行PCI治疗,术前均再次服用300mg负荷剂量的氯吡格雷。主要观察指标为术后8、24h的肌酸激酶(CK)、肌酸激酶同工酶(CK-MB)水平的变化和术后24h的肌钙蛋白(cTnI)超过正常上限的比例、30d的主要心脏不良事件(MACE,死亡、再发心肌梗死、再次血运重建)。结果PCI术后24h的CK、CK-MB水平,对照组显著高于强化组〔(4.1±0.4),(0.38±0.12)g/Lvs(3.2±0.5),(0.31±0.09)g/L;P<0.05〕;而术后8h的CK、CK-MB水平两组无显著性差异;术后24h的cTnI超过正常上限的比例及CK、CK-MB水平超过正常上限3倍的比率,差异有统计学意义(8.5%、6.4%、6.4%vs26.7%、15.6%、17.8%;P<0.05);术后30d强化组的MACE发生率12.8%,低于对照组17.8%,但无显著性差异。结论对于行PCI治疗的老年ACS患者,高剂量的阿托伐他汀短期预处理可以减轻PCI术中的心肌损伤。
Objective To investigate the protective effects of intensive pretreatment with short-term high-dose atorvastatin on percutaneous coronary intervention (PCI) in the elderly patients with non ST-segment elevation acute coronary syndrome (NSTEACS). Methods A total of 92 elderly ACS patients hospitalized for PCI were randomly divided into intensive group (47 cases treated with atorvastatin 40 mg / d pretreatment for 3 ~ 5 days before PCI) and control group Statin 10mg / d pretreatment 3 ~ 5d, a total of 45 cases), the rest of the drug treatment of two groups similar to the PCI treatment before surgery were again taking 300mg loading dose of clopidogrel. MAIN OUTCOME MEASURES: The changes of creatine kinase (CK) and creatine kinase (CK-MB) at 8 and 24 hours after operation and the ratio of cTnI beyond the upper limit of normal after 24 hours and 30 days Major adverse cardiac events (MACE, death, recurrent myocardial infarction, revascularization). Results The levels of CK and CK-MB at 24h after PCI were significantly higher than those in the control group (4.1 ± 0.4 vs 0.38 ± 0.12 vs 3.2 ± 0.5 and 0.31 ± 0.09 g / L, respectively) P <0.05], while there was no significant difference between CK and CK-MB levels at 8h after operation. The ratio of cTnI beyond the upper limit of normal after operation and the ratio of CK and CK-MB over 3 times upper limit of normal at 24h after operation were The incidence of MACE in the intensive group was 12.8% at 30 days after operation, which was lower than that in the control group (17.8%), but no significant difference (P> 0.05) Sex differences. Conclusions Short-term high-dose atorvastatin may reduce myocardial damage during PCI in elderly ACS patients undergoing PCI.