瑞舒伐他汀治疗急性ST段抬高型心肌梗死患者经皮冠状动脉介入术后的临床研究

发布时间：2018-03-13 17:45

本文选题：瑞舒伐他汀　切入点：急性ST段抬高型心肌梗死　出处：《中国临床药理学杂志》2017年18期 　论文类型：期刊论文

【摘要】：目的探讨术前瑞舒伐他汀不同预处理对长期或未服用他汀药物的急性ST段抬高型心肌梗死(STEMI)直接经皮冠状动脉介入治疗(PCI)患者心肌再灌注和近期疗效的影响。方法将170例STEMI患者按起病前是否服用他汀类药物超过3个月,首先分为长期服用他汀组患者45例(长期他汀干预组)及未长期服用他汀患者125例(起病前未曾服用过或服用时间在3月内者)。将125例未长期服用他汀患者随机分为大剂量预处理组64例和常规剂量预处理组61例。大剂量预处理组于术前30 min给予口服瑞舒伐他汀20 mg,术后继续口服瑞舒伐他汀10 mg qn,共40 d;常规剂量预处理组及长期他汀干预组均于术前30min给予口服瑞舒伐他汀10 mg,术后继续口服瑞舒伐他汀10 mg qn,共40 d。所有受试者PCI术前即刻均给予口服阿司匹林300 mg顿服+氯吡格雷600 mg顿服,术后给予阿司匹林100 mg,qd,长期口服+氯吡格雷75 mg qd,至少12个月。比较3组患者心肌再灌注情况、左心室舒张末期内径(LVEDD)、左室短轴缩短率(FS)、左心室射血分数(LVEF)、主要不良心血管事件和药物不良反应发生情况。结果 PCI术后,长期他汀干预组、大剂量预处理组和常规剂量预处理组心肌再灌注达到TIMI 3级的比例分别为95.56%,93.75%和85.25%;心电图ST段回落率(STR)分别为95.56%,93.75%和86.89%;再灌注心律失常发生率分别为57.78%,60.94%和36.07%,差异均有统计学意义(均P0.05)。长期他汀干预组、大剂量预处理组和常规剂量预处理组术后40 d时LVEDD分别为(51.88±4.79),(52.80±4.82)和(52.85±4.72)mm,FS分别为(40.05±2.25)%,(39.65±2.89)%和(34.05±2.89)%,LVEF分别为(54.08±6.22)%,(53.78±6.92)%和(47.05±6.10)%,分别与术后7 d的LVEDD、FS、LVEF比较,差异均有统计学意义(均P0.05)。长期他汀干预组出现的主要心血管不良事件主要有再发心绞痛1例,心源性休克3例,心力衰竭1例,严重室性心律失常2例,心血管不良事件发生率为15.56%(7/45例);大剂量预处理组出现的主要心血管不良事件主要有再发心绞痛3例,心源性休克1例,心力衰竭4例,严重室性心律失常3例,死亡1例,心血管不良事件发生率为18.75%(12/64例),分别与常规剂量预处理组比较,差异均有统计学意义(均P0.05)。结论长期服用他汀药物的STEMI患者,直接PCI术前给予常规剂量瑞舒伐他汀预处理,即可进一步提高心肌组织灌注水平,保护心肌,减少严重心律失常的发生率,改善近期疗效。
[Abstract]:Objective to investigate the effects of different preconditioning of resuvastatin on myocardial reperfusion and short-term efficacy of percutaneous coronary intervention (PCI) in patients with acute ST-segment elevation myocardial infarction (STEMI) who have not taken statins for a long time. Method: 170 patients with STEMI were treated with statins for more than 3 months before the onset of the disease. The patients were divided into long-term statins group (long-term statins intervention group) and long-term statins group (long-term statins intervention group) and 125 patients without long-term statins (before onset or within March). 125 patients without long-term statins were randomly assigned to take statins. High dose preconditioning group (n = 64) and routine dose preconditioning group (n = 61) were divided into high dose preconditioning group (n = 64) and conventional preconditioning group (n = 61). Both the group and the long-term statin intervention group were given resuvastatin 10mg / g 30 minutes before operation, followed by resuvastatin 10mg QN for 40 days. All subjects were given aspirin 300mg / d immediately before operation for clopidogrel 600mg / d. Aspirin 100 mg / g QD and clopidogrel 75 mg QD were given orally for at least 12 months. Left ventricular end-diastolic diameter (LVEDDN), left ventricular short-axis shortening rate (LVEFN), left ventricular ejection fraction (LVEF), major adverse cardiovascular events and adverse drug reactions were observed. Results after PCI, long-term statins were used as intervention group. In the high-dose preconditioning group and the conventional preconditioning group, the ratio of myocardial reperfusion to TIMI 3 was 93.75% and 85.25%, the St segment receding rate was 95.56% and 86.89%, and the incidence of reperfusion arrhythmia was 57.78% and 36.07%, respectively. Statistical significance (P 0.05). Long term statins intervention group, The LVEDD of high-dose preconditioning group and conventional preconditioning group were 51.88 卤4.79 卤52.80 卤4.82) and 52.85 卤4.72 mm / min respectively at 40 days after operation. The LVEDD was 40.05 卤2.25 卤2.89% and 34.05 卤2.89% respectively. The LVEDD was 54.08 卤6.22 卤6.92% and 47.05 卤6.10%, respectively, compared with the LVEDDD FSLVEF on the 7th day after operation. The main cardiovascular adverse events in the long-term statins intervention group included recurrent angina pectoris (1 case), cardiogenic shock (3 cases), heart failure (1 case), and severe ventricular arrhythmia (2 cases). The incidence of cardiovascular adverse events was 15.56 / 45, and the main cardiovascular adverse events in the high-dose preconditioning group included recurrent angina pectoris (3 cases), cardiogenic shock (1 case), heart failure (4 cases), severe ventricular arrhythmia (3 cases), and death (1 case). The incidence of cardiovascular adverse events was 18.75 / 12 / 64 cases, which was significantly different from that in the routine dose preconditioning group (P 0.05). Conclusion the patients with STEMI who take statins for a long time should be pretreated with the routine dose of recuvastatin before direct PCI. It can further improve myocardial perfusion, protect myocardium, reduce the incidence of severe arrhythmia, and improve the short-term curative effect.
【作者单位】：中国人民解放军武汉总医院心血管内科;
【基金】：湖北省科技支撑计划基金资助项目(2014BCH051)
【分类号】：R542.22

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