【摘要】：目的探討圍術(shù)期他汀強化治療對ST段抬高型心肌梗死(STEMI)老年患者經(jīng)皮冠狀動脈介入術(shù)(PCI)后冠狀動脈血流、近期主要不良心血管事件(MACE)和安全性的影響。方法入選入院前2 w未接受他汀類藥物治療的60歲以上STEMI患者80例,隨機分為強化他汀組(n=40)和對照組(n=40),強化他汀組于術(shù)前2 h內(nèi)及術(shù)后1 w均給予阿托伐他汀鈣40 mg/d口服,1 w后改成20 mg/d,對照組入院后每晚睡前給予阿托伐他汀鈣20 mg口服,療程均為30 d。觀察兩組術(shù)后即刻TIMI血流分級、ST段抬高總和回落百分比、血漿肌鈣蛋白(c Tn I)、白細胞介素(IL)-10、內(nèi)皮型一氧化氮合酶(e NOS)水平的變化。隨訪30 d MACE(心源性死亡、心力衰竭、非致死性AMI、梗死后心絞痛、靶血管重運)的發(fā)生率以及一些安全性指標(肝酶、肌酸激酶等)的變化。結(jié)果強化他汀組術(shù)后即刻TIMI3級血流比例、術(shù)后心電圖ST段抬高總和回落百分比≥50%的比例明顯高于對照組(P0.05)。與PCI前相比,術(shù)后兩組c Tn I、IL-10水平明顯增加(P0.01),e NOS明顯降低(P0.01),但強化組CTn I升高水平較對照組低,IL-10、e NOS水平較對照組高(P0.05)。隨訪30 d強化組MACE發(fā)生率以及肝功、肌肉損害等不良反應(yīng)發(fā)生率與對照組相比均無統(tǒng)計學(xué)差異(P0.05)。結(jié)論老年STEMI患者圍術(shù)期強化他汀治療可能通過抑制急診PCI術(shù)后炎癥反應(yīng)減少無復(fù)流的發(fā)生,減輕心肌損傷,并改善近期預(yù)后。
[Abstract]:Objective to investigate the effect of intensive perioperative statine therapy on coronary blood flow, (MACE) and safety after percutaneous coronary intervention (PCI) in elderly patients with ST segment elevation myocardial infarction (STEMI) after percutaneous coronary intervention (PCI). Methods 80 STEMI patients over 60 years old who were not treated with statins 2 weeks before admission were randomly divided into intensive statins group (n = 40) and control group (n = 40). The fortified statins group was treated with 40 mg/d of Atto vastatin calcium within 2 hours before operation and 1 week after operation, and the control group was treated with 20 mg of Atto vastatin calcium every night after admission. The course of treatment was 30 days for all patients in the intensive statins group, and the control group was treated with 20 mg of Atto vastatin calcium every night after being admitted to the hospital for 30 days. The blood flow grading of TIMI, the percentage of total reduction of St segment elevation, plasma troponin (c Tn I), interleukin-10 (IL)-10) and endothelial nitric oxide synthase (Enos) (e NOS) levels were observed immediately after operation in the two groups. The incidence of cardiac death, heart failure, non-fatal AMI, post-infarction angina pectoris, target vessel revascularization and some safety indexes (liver enzyme, creatine kinase, etc.) were followed up for 30 d MACE (. Results the percentage of TIMI3 grade blood flow immediately after operation and the percentage of total reduction of ST segment elevation 鈮，

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