本文選題：心肌梗死 + 心肌再灌注��； 參考：《重慶醫(yī)學》2017年02期

【摘要】：目的探討術前瑞舒伐他汀不同預處理對長期服用他汀藥物的急性ST段型抬高心肌梗死(STEMI)直接直接經皮冠狀動脈介入治療(PPCI)患者心肌再灌注及迷走神經功能的影響。方法按是否起病前服用他汀類藥物超過3個月,將170例首次STEMI患者分為長期他汀干預組、大劑量組和常規(guī)劑量組。術前、術后分別檢測肌酸激酶同工酶MB(CK-MB)、肌鈣蛋白T(TnT)、超敏C反應蛋白(hs-CRP)、白細胞介素-6(IL-6)及血脂水平;評價心肌再灌注情況;術后7、40d檢測心率減速力(DC)、化學反射敏感性(ChRS);術后40d內觀察主要心血管不良事件及藥物不良反應的發(fā)生。結果術后TIMI TMPG 3級,RA(室速、竇緩、房室傳導阻滯)發(fā)生,心電圖抬高ST回落率術后及再灌注心律失常方面,長期他汀干預組與大劑量組均明顯優(yōu)于常規(guī)劑量組(P0.05);術后7、40d時,兩組DC值、低風險值比例和ChRS值均較常規(guī)劑量組明顯升高(P0.05),高風險值比例均較常規(guī)劑量組明顯降低(P0.05)。在再發(fā)心絞痛、心力衰竭、嚴重室性心律失常(多形性室性早搏、非持續(xù)性室性心動過速)、心臟彩超左室射血分數(shù)指標方面,兩組均優(yōu)于常規(guī)劑量組(P0.05)。結論長期服用他汀藥物病史患者術前瑞舒伐他汀10mg預處理,即可進一步提高STEMI患者PPCI后心肌再灌注水平,增加迷走神經活性,改善近期預后。
[Abstract]:Objective to investigate the effects of different preconditioning of resuvastatin on myocardial reperfusion and vagal function in patients with acute ST-segment elevation myocardial infarction (STEMI) treated with statin for a long time after direct percutaneous coronary intervention (PPCI). Methods 170 patients with STEMI were divided into long-term statin intervention group, high dose group and routine dose group according to whether to take statins for more than 3 months before onset. Before and after operation, the levels of creatine kinase isoenzyme MB (CK-MB), troponin T (TNT), hypersensitive C-reactive protein (hs-CRP), interleukin-6 (IL-6) and serum lipids were measured, respectively. Heart rate deceleration (DC), chemical reflex sensitivity (ChRS) were measured at 7 ~ 40 days after operation, and major adverse cardiovascular events and adverse drug reactions were observed within 40 days after operation. Results after operation, TIMI TMPG grade 3 RA (ventricular tachycardia, sinus bradycardia, atrioventricular block), ECG elevation St lowering rate and reperfusion arrhythmias were significantly better in the long-term statin intervention group and the high-dose group than in the conventional dose group (P0.05), and at 740 days after operation, there was no significant difference between the long-term statin intervention group and the high dose group (P0.05). DC value, low risk value ratio and ChRS value of both groups were significantly higher than those of routine dose group (P0.05), and the proportion of high risk value were significantly lower than that of routine dose group (P0.05). In terms of recurrent angina, heart failure, severe ventricular arrhythmias (pleomorphic ventricular premature beats, unsustainable ventricular tachycardia), left ventricular ejection fraction of color Doppler echocardiography, both groups were superior to the conventional dose group (P0.05). Conclusion Preconditioning of recuvastatin 10mg in patients with long-term history of statin can further improve myocardial reperfusion, increase vagal nerve activity and improve short-term prognosis in patients with STEMI.
【作者單位】： 廣州軍區(qū)武漢總醫(yī)院心血管內科;
【基金】：武漢市中青年醫(yī)學骨干人才培養(yǎng)工程(武衛(wèi)生計生201477)
【分類號】：R542.22

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