不同剂量阿托伐他汀与瑞舒伐他汀对急性ST段抬高型心肌梗死急诊介入治疗患者影响的对比研究

发布时间：2018-01-14 20:05

  本文关键词：不同剂量阿托伐他汀与瑞舒伐他汀对急性ST段抬高型心肌梗死急诊介入治疗患者影响的对比研究　出处：《广西医科大学》2015年硕士论文　论文类型：学位论文

  更多相关文章： 急性心肌梗死 瑞舒伐他汀 阿托伐他汀 急诊介入治

【摘要】：目的 探讨不同剂量阿托伐他汀与瑞舒伐他汀对急性ST段抬高型心肌梗死(STEMI)急诊介入治疗(PCI)患者的有效性及安全性,为临床合理用药提供科学依据。方法 选取220例来自广西医科大学第六附属医院2013年7月1日至2014年12月31日期间住院的急性ST段抬高型心肌梗死患者,所有患者均行急诊介入治疗;随机分为4组,a组:阿托伐他汀常规剂量组(55例),在手术之前予口服阿托伐他汀钙片20mg,手术之后继续予20mg/d;b组:瑞舒伐他汀常规剂量组(55例),在手术之前口服瑞舒伐他汀钙片10mg,手术之后继续予10mg/d;c组:阿托伐他汀负荷剂量组(55例),手术之前口服阿托伐他汀钙片40mg,手术之后继续予40mg/d;d组:瑞舒伐他汀负荷剂量组(55例),手术之前口服瑞舒伐他汀钙片20mg,手术之后继续予20mg/d。4组患者按上述服药1个月。比较4组术前、术后肌酸激酶同工酶(CK-MB)、血脂、丙氨酸氨基转移酶(ALT)、血清肌酐(Cr)、肌钙蛋白I(c Tn I)、超敏C反应蛋白(hs-CRP)以及白介素6(IL-6)、心肌血流灌注等,记录4组患者主要不良心血管事件(MACE)。结果 1 4组患者一般资料,包括性别、年龄、发病时间、吸烟、高血压病史、高血脂病史、糖尿病病史、心肌梗死病史、冠心病家族史、心功能分级等方面对比,差异均无统计学意义(P0.05);2 4组患者在介入治疗及疗效对比,包括血管病变、介入支架数量、支架宽度、支架长度、最大球囊扩张压力、手术介入时间等,差异均无统计学意义(P0.05);冠脉TIMI TMPG分级血流3级对比,两个负荷剂量组达标率高于两个常规剂量组(P0.05)。3 4组患者术前心肌酶包括CK-MB、c Tn I水平比较,术前对比差异均无统计学意义(P0.05);手术后24小时4组患者的CK-MB、c Tn I水平比术前明显升高,对比有统计学差异(P0.05);手术后24小时4组患者的CK-MB、c Tn I水平组间对比有统计学差异(P0.05),两个负荷剂量组升高幅度均小于两个常规剂量组(P0.05),而且负荷剂量组瑞舒伐他汀组升高幅度小于负荷剂量阿托伐他汀组(P0.05);4 4组患者的hs-CRP、IL-6水平术前对比差异无统计学意义(P0.05);术后24小时,4组患者hs-CRP、IL-6水平均明显升高,与术前对比有统计学差异(P0.05);4组组间对比差异有统计学意义(P0.05),c的hs-CRP、IL-6水平低于a组和b组,对比均有统计学差异(P0.05),d组低于a组、b组、c组,对比均有统计学差异(P0.05);术后7天、术后1个月,4组患者的hs-CRP、IL-6水平逐渐下降,组间对比均有统计学差异,b组术后7天、术后1个月的hs-CRP、IL-6水平均低于a组(P0.05),c组低于a组及b组(P0.05),d组低于a组、b组及c组(P0.05)。5 4组患者术前TG、TC、LDL-C、HDL-C水平差异均无统计学意义(P0.05),患者术后1个月,均明显下降(P0.05),4组对比差异有统计学意义(P0.05),b组LDL-C水平低于a组(P0.05),c组TC、TG、LDL-C水平低于a组和b组,HDL-C水平高于a组和b组,对比差异均有统计学意义(P0.05),d组TC、TG、LDL-C水平低于a组和b组,HDL-C水平高于a组和b组,对比差异均有统计学意义(P0.05),d组TC、LDL-C水平低于c组(P0.05)。6 4组患者术前Cr水平对比差异无统计学意义(P0.05),术后24小时4组肌酐(Cr)水平有所升高,a组、b组、c组的Cr水平与手术之前对比,差异有统计学意义(P0.05),4组患者手术之后24小时Cr水平对比差异有统计学意义(P0.05),c组分别与a组和b组对比,均有统计学差异(P0.05),d组肌酐水平低于a组和b组(P0.05);术后7天、1个月,4组患者肌酐(Cr)水平均接近正常,4组对比无统计学差异(P0.05)。7 4组患者药物不良反应包括谷丙转氨酶(ALT)升高≥3倍、血肌酐肌酐2.0mg/d1、横纹肌溶解、肌痛、新发糖尿病、过敏反应对比差异无统计学意义(P0.05)。8比较4组患者术后不良心血管事件发生情况,术后1个月随访,a组6例:心源性死亡3例,术后心梗2例,缺血性脑卒中1例;b组7例:心源性死亡3例,术后心梗2例,缺血性脑卒中2例;c组2例:术后心梗1例,缺血性脑卒中1例;d组2例:心源性死亡1例,缺血性脑卒中1例;4组组间对比有统计学差异(P0.05),c组分别与a组和b组对比差异均有统计学差异(P0.05),d组分别与a组和b组对比均有统计学差异(P0.05),c组与d组对比无统计学差异(P0.05)。结论:1常规剂量瑞舒伐他汀(10mg)对比常规剂量阿托伐他汀(20mg),能更好地降低血脂和急诊PCI术后炎症反应;2负荷剂量阿托伐他汀(40mg)治疗降脂效果、降低急性心肌梗死PCI术后炎症反应优于常规剂量阿托伐他汀(20mg)和常规剂量瑞舒伐他汀(10mg);3负荷剂量瑞舒伐他汀(20mg)治疗降脂效果、降低急性心肌梗死PCI术后炎症反应优于常规剂量阿托伐他汀(20mg)、常规剂量瑞舒伐他汀(10mg)和负荷剂阿托伐他汀(40mg);4急性心肌梗死术前早期应用负荷量他汀类药物及术后继续负荷剂量用药(阿托伐他汀40mg或瑞舒伐他汀20mg)对比术前、术后常规剂量用药(阿托伐他汀20mg或瑞舒伐他汀10mg)可明显改善心肌灌注、降低术后不良心血管事件发生率;5急性心肌梗死术前早期应用负荷量他汀类药物及术后继续负荷剂量用药(阿托伐他汀40mg或瑞舒伐他汀20mg)对比术前、术后常规剂量用药(阿托伐他汀20mg或瑞舒伐他汀10mg)不明显增加肝肾功能损害、肌痛、横纹肌溶解等药物不良反应。
[Abstract]:Objective to investigate the effects of different doses of atorvastatin and rosuvastatin on acute ST elevation myocardial infarction (STEMI) emergency interventional therapy (PCI) efficacy and safety of patients, to provide scientific basis for clinical rational drug use. Methods 220 cases of patients with acute ST from Guangxi Medical University Sixth Hospital Affiliated Hospital from July 1, 2013 to December 31, 2014 period elevation myocardial infarction, all patients underwent emergency interventional therapy; were randomly divided into 4 groups, a group, low-dose atorvastatin group (55 cases), before surgery for oral surgery after continue to Atorvastatin Calcium Tablets 20mg, 20mg/d; group B: rosuvastatin conventional dose group (55 cases), in oral surgery before Rosuvastatin Calcium Tablets 10mg, after the operation to continue to 10mg/d; C group: atorvastatin loading dose group (55 cases), oral surgery before Atorvastatin Calcium Tablets 40mg, after the operation to continue to 40mg /d; group D: rosuvastatin loading dose group (55 cases), oral surgery before Rosuvastatin Calcium Tablets 20mg, after the operation to continue to 20mg/d.4 patients according to the medication for 1 months. The 4 groups before surgery, postoperative creatine kinase isoenzyme (CK-MB), blood lipid, serum alanine aminotransferase (ALT), serum creatinine (Cr), troponin I (C Tn I), high sensitive C reactive protein (hs-CRP) and interleukin 6 (IL-6), myocardial perfusion, records of 4 patients of major adverse cardiovascular events (MACE). The results of 14 groups of patients with general information, including sex, age, time of onset, smoking, hypertension the history, hyperlipidemia, diabetes mellitus, history of myocardial infarction, family history of coronary heart disease, compared the cardiac functional grading, there were no significant differences (P0.05); 24 patients in the comparison of interventional therapy and curative effect, including blood vessel disease, interventional stent number, stent length, maximum width of stent, balloon dilatation A pressure, surgical intervention time, there were no significant differences (P0.05); coronary TIMI TMPG grade 3 flow between two loading dose group compliance rate is higher than the conventional dose group (P0.05 two).3 4 groups of patients with preoperative myocardial enzymes including CK-MB, C Tn I, preoperative contrast difference no statistical significance (P0.05); CK-MB 24 hours of the 4 groups of patients after surgery, C Tn I was significantly higher than the preoperative contrast, there were significant differences (P0.05); CK-MB 24 hours of the 4 groups of patients after surgery, the C Tn I levels between the groups had significant difference (P0.05), two loading dose group increased two less than the conventional dose group (P0.05), and group loading dose rosuvastatin group increased by less than the loading dose of atorvastatin group (P0.05 group); 44 patients with hs-CRP, compared with no significant differences in IL-6 level before operation (P0.05); 24 hours after surgery, 4 patients in the hs-CRP group. The level of IL-6 鍧囨槑鏄惧崌楂，

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