本文選題：瑞舒伐他汀 + 經(jīng)皮冠狀動脈介入治療��； 參考：《河北醫(yī)科大學》2015年碩士論文

【摘要】：目的:本研究通過比較不同劑量的瑞舒伐他汀(Rosuvastatin,Rosu)對擇期行經(jīng)皮冠狀動脈成形術(shù)(percutaneous coronary intervention,PCI)的急性冠脈綜合征(acute coronary syndrome,ACS)患者治療療效,探討瑞舒伐他汀減少ACS患者圍PCI期心肌損傷發(fā)生情況的機制及術(shù)后30天的臨床療效,為擇期行PCI術(shù)ACS患者應(yīng)用他汀類藥物提供客觀依據(jù)。方法:本研究入選60例ACS并擇期行PCI術(shù)患者,依據(jù)隨機數(shù)字表法隨機分為3組。瑞舒伐他汀低劑量治療組(20例,5mg/qn,至少口服1月);瑞舒伐他汀常規(guī)劑量治療組(20例,10mg/qn,至少口服1月);瑞舒伐他汀強化劑量治療組(20例,20mg/qn,至少口服1月)。所有入選患者入院后詳細記錄臨床資料,包括姓名、性別、年齡、高血壓史、糖尿病史、個人吸煙史、家族史、三大常規(guī)、血糖、血脂(總膽固醇TC、甘油三酯TG、低密度脂蛋白LDL-C、高密度脂蛋白HLD-C)、肝功能、腎功能、CK-MB、hs-c Tn I、NT-pro BNP、PTX3、處理血管數(shù)量等相關(guān)數(shù)據(jù)。觀察指標:(1)三組患者PCI術(shù)前、術(shù)后24h CK-MB(creatine kinase-MB,CK-MB)、hs-c Tn I(cardiac troponin I,c Tn I)水平變化;(2)三組患者PCI術(shù)前、術(shù)后3天、術(shù)后30天血漿PTX3(pentraxin 3,PTX3)、NT-pro BNP(N-terminal pro-brain natriuretic peptide,NT-pro BNP)水平變化;(3)三組患者PCI術(shù)后30天內(nèi)主要不良心血管事件(major adverse cardiac events,MACE)包括心臟死亡、心肌梗死、再次血運重建、心衰、反復(fù)心絞痛。(4)三組患者藥物不良反應(yīng)發(fā)生情況。結(jié)果:1三組患者入院后的臨床基本資料,包括年齡、性別、高血壓史、糖尿病史、吸煙史、TC、TG、LDL-C、HDL-C、CK-MB、hs-c Tn I、PTX3、NT-pro BNP、血管緊張素轉(zhuǎn)換酶抑制劑(ACEI)/血管緊張素受體拮抗劑(ARB)、β受體阻滯劑、阿司匹林、氯吡格雷的應(yīng)用等均無統(tǒng)計學差異(P0.05)。2以hs-c Tn I和CK-MB作為心肌損傷標記物 2.1三組患者PCI術(shù)后24小時hs-c Tn I水平均較術(shù)前升高,差異有統(tǒng)計學意義(P0.05)。強化劑量組升高幅度明顯低于低劑量組、常規(guī)劑量組,常規(guī)劑量組升高幅度低于低劑量組,差異有統(tǒng)計學意義(P0.05)。2.2三組患者PCI術(shù)后24小時CK-MB水平均較術(shù)前升高,差異有統(tǒng)計學意義(P0.05)。強化劑量組升高幅度明顯低于低劑量組、常規(guī)劑量組,常規(guī)劑量組升高幅度低于低劑量組,差異有統(tǒng)計學意義(P0.05)。3三組患者PCI術(shù)后3天、30天NT-pro BNP水平變化3.1三組患者術(shù)后3天NT-pro BNP水平較術(shù)前升高,差異有統(tǒng)計學意義(P0.05)。低劑量組、常規(guī)劑量組、強化劑量組之間進行比較,均略有升高,差異無統(tǒng)計學意義(P0.05)。3.2三組患者術(shù)后30天NT-pro BNP水平較術(shù)前降低,差異有統(tǒng)計學意義(P0.05)。低劑量組、常規(guī)劑量組、強化劑量組之間進行比較,均略有降低,差異無統(tǒng)計學意義(P0.05)。4三組患者PCI術(shù)后3天、30天PTX3水平變化4.1三組患者術(shù)后3天PTX3水平較術(shù)前升高,差異無統(tǒng)計學意義(P0.05)。低劑量組、常規(guī)劑量組、強化劑量組之間進行比較,均略有升高,差異無統(tǒng)計學意義(P0.05)。4.2三組患者術(shù)后30天PTX3水平較術(shù)前降低,差異無統(tǒng)計學意義(P0.05)。低劑量組、常規(guī)劑量組、強化劑量組之間進行比較,均略有降低,差異無統(tǒng)計學意義(P0.05)。5三組患者PCI術(shù)后30天內(nèi)MACE發(fā)生情況,差異無統(tǒng)計學意義(P0.05)。6三組患者藥物不良反應(yīng)發(fā)生情況,差異無統(tǒng)計學意義(P0.05)。結(jié)論:1瑞舒伐他汀強化劑量治療在ACS患者擇期PCI術(shù)圍手術(shù)期心肌保護作用上優(yōu)于低劑量治療和常規(guī)劑量治療。2瑞舒伐他汀能夠降低ACS患者PCI術(shù)后30天NT-pro BNP水平,但不同劑量組之間無統(tǒng)計學差異。3瑞舒伐他汀能夠降低ACS患者PCI術(shù)后30天PTX3水平,但不同劑量組之間、不同時間段之間無統(tǒng)計學差異。4三組患者PCI術(shù)后30天MACE發(fā)生率無統(tǒng)計學差異。 5三組患者均未發(fā)生藥物不良反應(yīng)。
[Abstract]:Objective: To investigate the effects of different doses of Rosuvastatin (Rosu) on acute coronary syndrome (acute coronary syndrome, ACS) in patients undergoing selective percutaneous coronary angioplasty (percutaneous coronary intervention, PCI), and to explore the effect of rosuvastatin on the incidence of myocardial injury in ACS patients. The mechanism and the clinical efficacy of 30 days postoperatively provide an objective basis for the use of statins for PCI ACS patients undergoing elective operation. Methods: This study was selected for 60 cases of ACS and selected for PCI surgery, and randomly divided into 3 groups according to the random digital table method. The low dose treatment group of rosuvastatin (20 cases, 5mg /qn, at least oral January); routine dose treatment of rosuvastatin. Treatment group (20 cases, 10mg/qn, at least oral January); rosuvastatin intensive dose treatment group (20 cases, 20mg/qn, at least orally for January). All selected patients were enrolled in detailed clinical records, including name, sex, age, hypertension, diabetes history, personal history of smoking, family history, three routine, blood glucose, triglyceride TG, low level of triglyceride (triglyceride TG, low) Density lipoprotein LDL-C, high density lipoprotein HLD-C), liver function, renal function, CK-MB, HS-C Tn I, NT-pro BNP, PTX3, and the number of vessels dealing with blood vessels. (1) three groups of patients before and after operation 24h CK-MB (2) three groups of patients before, 3 days after surgery, 30 days after the operation, plasma PTX3 (pentraxin 3, PTX3), NT-pro BNP (N-terminal pro-brain natriuretic peptide, NT-pro BNP) level changes; (3) the three group of patients within 30 days after 30 days of cardiac death, myocardial infarction, re reconstruction of blood, heart failure, recurrent angina. (4) three groups of patients (4) Results: 1. Results: 1 the basic clinical data of the three groups were: age, sex, hypertension, diabetes, smoking history, TC, TG, LDL-C, HDL-C, CK-MB, HS-C Tn I, PTX3, NT-pro BNP, angiotensin converting enzyme inhibitors (ACEI) / angiotensin receptor antagonists, beta blockers, aspirin, chlorine There was no statistically significant difference in the application of pyridine Gray (P0.05).2 with HS-C Tn I and CK-MB as a marker of myocardial injury 2.1. The level of HS-C Tn I in 24 hours after PCI was higher than that before the operation. The difference was statistically significant (P0.05). The increase in the dose group was significantly lower than that in the low dose group. The routine dose group was lower than the conventional dose group. In the low dose group, the difference was statistically significant (P0.05) in group.2.2 three, the level of CK-MB was higher at 24 hours after PCI, and the difference was statistically significant (P0.05). The increase in the intensive dose group was significantly lower than that in the low dose group. The routine dose group was lower than the low dose group, and the difference was statistically significant (P0.05) P of the.3 three groups. 3 days after CI, 30 days NT-pro BNP level changes in 3.1 three patients, 3 days after the operation, NT-pro BNP level was higher than before the operation, the difference was statistically significant (P0.05). Low dose group, routine dose group, enhanced dose group comparison, the difference was slightly higher, the difference was not statistically significant (P0.05).3.2 three after 30 days NT-pro BNP level was lower than before the operation, The difference was statistically significant (P0.05). The comparison between the low dose group, the routine dose group and the intensive dose group decreased slightly. The difference was not statistically significant (P0.05) in the group.4 three, 3 days after PCI, and the 30 day PTX3 level in 4.1 three groups, the PTX3 level was higher than that before the operation, the difference was not statistically significant (P0.05). The low dose group and the conventional dose were not significant. Group, compared with the intensive dose group, the difference was slightly higher, the difference was not statistically significant (P0.05), the level of PTX3 in group.4.2 three was lower than before operation, the difference was not statistically significant (P0.05). The low dose group, the routine dose group, and the contrast between the intensive dose groups were slightly lower, the difference was not statistically significant (P0.05).5 three patients PCI The incidence of MACE within 30 days after operation was not statistically significant (P0.05) and there was no significant difference in the occurrence of adverse drug reactions in the group.6 three patients (P0.05). Conclusion: 1 the enhanced dose therapy of rosuvastatin is superior to low dose and routine dose treatment of.2 resuvastatin in the perioperative myocardial protection of ACS patients undergoing selective PCI surgery. Enough to reduce the level of NT-pro BNP at 30 days after PCI operation in ACS patients, but there was no statistical difference between different dosage groups,.3 could reduce the PTX3 level of ACS patients at 30 days after PCI operation, but there was no statistical difference between different doses groups, and there was no statistical difference between the 30 days after PCI operation in the group of.4 three groups. The 5 three groups were not different. There is a drug adverse reaction.

【學位授予單位】：河北醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2015
【分類號】：R541.4

【參考文獻】

相關(guān)期刊論文 前10條

1 黃宇翔;魏芝寶;姚超永;;術(shù)前強化瑞舒伐他汀鈣治療對急性ST段抬高型心肌梗死患者介入術(shù)后的臨床觀察[J];血栓與止血學;2014年06期

2 何凌宇;項軍;梅健;王巖;王磊;劉成;薛松;;負荷劑量瑞舒伐他汀對急性冠脈綜合征介入治療后患者血漿N-端腦利鈉肽前體的影響[J];臨床醫(yī)學;2014年11期

3 王海峰;郭偉新;謝南姿;李健;沈藝;;烏司他丁注射液改善急性肺損傷兔循環(huán)內(nèi)皮祖細胞成血管能力及對PKB/eNOS/NO通路的影響[J];中西醫(yī)結(jié)合心腦血管病雜志;2014年10期

4 徐珊珊;王聃;康永亮;;瑞舒伐他汀對高脂飲食家兔動脈粥樣硬化斑塊及血脂的影響[J];中國老年保健醫(yī)學;2014年03期

5 盛建龍;王曉晨;許邦龍;吳繼雄;胡章樂;;負荷量瑞舒伐他汀對冠心病PCI術(shù)后預(yù)后的影響[J];安徽醫(yī)藥;2014年04期

6 胡大一;郭藝芳;;客觀認識2013ACC/AHA降膽固醇治療指南對我國臨床實踐的影響[J];中國循環(huán)雜志;2014年01期

7 李lm儐;崔煒;耿雪;;經(jīng)皮冠狀動脈介入治療前應(yīng)用他汀類藥物患者圍手術(shù)期心肌損傷的meta分析[J];臨床薈萃;2014年02期

8 趙建華;潘港;龍勝春;馮小堅;徐細平;;圍手術(shù)期不同劑量瑞舒伐他汀對老年急性非ST段抬高心肌梗死患者PCI術(shù)后影響[J];中國醫(yī)療前沿;2013年16期

9 吳丁燁;馮健;尤華彥;王強;曹華明;鐘艷芳;;瑞舒伐他汀與阿托伐他汀對冠心病患者Rho激酶活性和內(nèi)皮功能影響的比較[J];中國動脈硬化雜志;2013年01期

10 林春喜;林建聰;郭潤民;沈?qū)?馮鑒強;鄭東誕;;硫化氫通過調(diào)控JNK通路對抗高糖誘導(dǎo)的心肌細胞氧化應(yīng)激損傷[J];中國動脈硬化雜志;2013年01期

，

本文編號：1831285