本文關(guān)鍵詞：不同劑量阿托伐他汀與瑞舒伐他汀對(duì)急性ST段抬高型心肌梗死急診介入治療患者影響的對(duì)比研究　出處：《廣西醫(yī)科大學(xué)》2015年碩士論文　論文類型：學(xué)位論文

  更多相關(guān)文章： 急性心肌梗死 瑞舒伐他汀 阿托伐他汀 急診介入治

【摘要】：目的 探討不同劑量阿托伐他汀與瑞舒伐他汀對(duì)急性ST段抬高型心肌梗死(STEMI)急診介入治療(PCI)患者的有效性及安全性,為臨床合理用藥提供科學(xué)依據(jù)。方法 選取220例來(lái)自廣西醫(yī)科大學(xué)第六附屬醫(yī)院2013年7月1日至2014年12月31日期間住院的急性ST段抬高型心肌梗死患者,所有患者均行急診介入治療;隨機(jī)分為4組,a組:阿托伐他汀常規(guī)劑量組(55例),在手術(shù)之前予口服阿托伐他汀鈣片20mg,手術(shù)之后繼續(xù)予20mg/d;b組:瑞舒伐他汀常規(guī)劑量組(55例),在手術(shù)之前口服瑞舒伐他汀鈣片10mg,手術(shù)之后繼續(xù)予10mg/d;c組:阿托伐他汀負(fù)荷劑量組(55例),手術(shù)之前口服阿托伐他汀鈣片40mg,手術(shù)之后繼續(xù)予40mg/d;d組:瑞舒伐他汀負(fù)荷劑量組(55例),手術(shù)之前口服瑞舒伐他汀鈣片20mg,手術(shù)之后繼續(xù)予20mg/d。4組患者按上述服藥1個(gè)月。比較4組術(shù)前、術(shù)后肌酸激酶同工酶(CK-MB)、血脂、丙氨酸氨基轉(zhuǎn)移酶(ALT)、血清肌酐(Cr)、肌鈣蛋白I(c Tn I)、超敏C反應(yīng)蛋白(hs-CRP)以及白介素6(IL-6)、心肌血流灌注等,記錄4組患者主要不良心血管事件(MACE)。結(jié)果 1 4組患者一般資料,包括性別、年齡、發(fā)病時(shí)間、吸煙、高血壓病史、高血脂病史、糖尿病病史、心肌梗死病史、冠心病家族史、心功能分級(jí)等方面對(duì)比,差異均無(wú)統(tǒng)計(jì)學(xué)意義(P0.05);2 4組患者在介入治療及療效對(duì)比,包括血管病變、介入支架數(shù)量、支架寬度、支架長(zhǎng)度、最大球囊擴(kuò)張壓力、手術(shù)介入時(shí)間等,差異均無(wú)統(tǒng)計(jì)學(xué)意義(P0.05);冠脈TIMI TMPG分級(jí)血流3級(jí)對(duì)比,兩個(gè)負(fù)荷劑量組達(dá)標(biāo)率高于兩個(gè)常規(guī)劑量組(P0.05)。3 4組患者術(shù)前心肌酶包括CK-MB、c Tn I水平比較,術(shù)前對(duì)比差異均無(wú)統(tǒng)計(jì)學(xué)意義(P0.05);手術(shù)后24小時(shí)4組患者的CK-MB、c Tn I水平比術(shù)前明顯升高,對(duì)比有統(tǒng)計(jì)學(xué)差異(P0.05);手術(shù)后24小時(shí)4組患者的CK-MB、c Tn I水平組間對(duì)比有統(tǒng)計(jì)學(xué)差異(P0.05),兩個(gè)負(fù)荷劑量組升高幅度均小于兩個(gè)常規(guī)劑量組(P0.05),而且負(fù)荷劑量組瑞舒伐他汀組升高幅度小于負(fù)荷劑量阿托伐他汀組(P0.05);4 4組患者的hs-CRP、IL-6水平術(shù)前對(duì)比差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05);術(shù)后24小時(shí),4組患者h(yuǎn)s-CRP、IL-6水平均明顯升高,與術(shù)前對(duì)比有統(tǒng)計(jì)學(xué)差異(P0.05);4組組間對(duì)比差異有統(tǒng)計(jì)學(xué)意義(P0.05),c的hs-CRP、IL-6水平低于a組和b組,對(duì)比均有統(tǒng)計(jì)學(xué)差異(P0.05),d組低于a組、b組、c組,對(duì)比均有統(tǒng)計(jì)學(xué)差異(P0.05);術(shù)后7天、術(shù)后1個(gè)月,4組患者的hs-CRP、IL-6水平逐漸下降,組間對(duì)比均有統(tǒng)計(jì)學(xué)差異,b組術(shù)后7天、術(shù)后1個(gè)月的hs-CRP、IL-6水平均低于a組(P0.05),c組低于a組及b組(P0.05),d組低于a組、b組及c組(P0.05)。5 4組患者術(shù)前TG、TC、LDL-C、HDL-C水平差異均無(wú)統(tǒng)計(jì)學(xué)意義(P0.05),患者術(shù)后1個(gè)月,均明顯下降(P0.05),4組對(duì)比差異有統(tǒng)計(jì)學(xué)意義(P0.05),b組LDL-C水平低于a組(P0.05),c組TC、TG、LDL-C水平低于a組和b組,HDL-C水平高于a組和b組,對(duì)比差異均有統(tǒng)計(jì)學(xué)意義(P0.05),d組TC、TG、LDL-C水平低于a組和b組,HDL-C水平高于a組和b組,對(duì)比差異均有統(tǒng)計(jì)學(xué)意義(P0.05),d組TC、LDL-C水平低于c組(P0.05)。6 4組患者術(shù)前Cr水平對(duì)比差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05),術(shù)后24小時(shí)4組肌酐(Cr)水平有所升高,a組、b組、c組的Cr水平與手術(shù)之前對(duì)比,差異有統(tǒng)計(jì)學(xué)意義(P0.05),4組患者手術(shù)之后24小時(shí)Cr水平對(duì)比差異有統(tǒng)計(jì)學(xué)意義(P0.05),c組分別與a組和b組對(duì)比,均有統(tǒng)計(jì)學(xué)差異(P0.05),d組肌酐水平低于a組和b組(P0.05);術(shù)后7天、1個(gè)月,4組患者肌酐(Cr)水平均接近正常,4組對(duì)比無(wú)統(tǒng)計(jì)學(xué)差異(P0.05)。7 4組患者藥物不良反應(yīng)包括谷丙轉(zhuǎn)氨酶(ALT)升高≥3倍、血肌酐肌酐2.0mg/d1、橫紋肌溶解、肌痛、新發(fā)糖尿病、過(guò)敏反應(yīng)對(duì)比差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。8比較4組患者術(shù)后不良心血管事件發(fā)生情況,術(shù)后1個(gè)月隨訪,a組6例:心源性死亡3例,術(shù)后心梗2例,缺血性腦卒中1例;b組7例:心源性死亡3例,術(shù)后心梗2例,缺血性腦卒中2例;c組2例:術(shù)后心梗1例,缺血性腦卒中1例;d組2例:心源性死亡1例,缺血性腦卒中1例;4組組間對(duì)比有統(tǒng)計(jì)學(xué)差異(P0.05),c組分別與a組和b組對(duì)比差異均有統(tǒng)計(jì)學(xué)差異(P0.05),d組分別與a組和b組對(duì)比均有統(tǒng)計(jì)學(xué)差異(P0.05),c組與d組對(duì)比無(wú)統(tǒng)計(jì)學(xué)差異(P0.05)。結(jié)論:1常規(guī)劑量瑞舒伐他汀(10mg)對(duì)比常規(guī)劑量阿托伐他汀(20mg),能更好地降低血脂和急診PCI術(shù)后炎癥反應(yīng);2負(fù)荷劑量阿托伐他汀(40mg)治療降脂效果、降低急性心肌梗死PCI術(shù)后炎癥反應(yīng)優(yōu)于常規(guī)劑量阿托伐他汀(20mg)和常規(guī)劑量瑞舒伐他汀(10mg);3負(fù)荷劑量瑞舒伐他汀(20mg)治療降脂效果、降低急性心肌梗死PCI術(shù)后炎癥反應(yīng)優(yōu)于常規(guī)劑量阿托伐他汀(20mg)、常規(guī)劑量瑞舒伐他汀(10mg)和負(fù)荷劑阿托伐他汀(40mg);4急性心肌梗死術(shù)前早期應(yīng)用負(fù)荷量他汀類藥物及術(shù)后繼續(xù)負(fù)荷劑量用藥(阿托伐他汀40mg或瑞舒伐他汀20mg)對(duì)比術(shù)前、術(shù)后常規(guī)劑量用藥(阿托伐他汀20mg或瑞舒伐他汀10mg)可明顯改善心肌灌注、降低術(shù)后不良心血管事件發(fā)生率;5急性心肌梗死術(shù)前早期應(yīng)用負(fù)荷量他汀類藥物及術(shù)后繼續(xù)負(fù)荷劑量用藥(阿托伐他汀40mg或瑞舒伐他汀20mg)對(duì)比術(shù)前、術(shù)后常規(guī)劑量用藥(阿托伐他汀20mg或瑞舒伐他汀10mg)不明顯增加肝腎功能損害、肌痛、橫紋肌溶解等藥物不良反應(yīng)。
[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 鍧囨槑鏄懼崌楂，

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