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目的探讨负荷剂量阿托伐他汀对非ST段抬高急性冠状动脉综合征(NSTEACS)患者PCI围手术期的影响。方法将81例NSTEACS患者随机分为负荷治疗组41例和标准治疗组40例,负荷治疗组PCI术前12 h顿服阿托伐他汀80 mg,PCI术前2 h追加阿托伐他汀40 mg。2组术前、术后8和24 h抽取肘静脉血,检测血清肌酸激酶同工酶(CK-MB)、血浆肌钙蛋白(cTnI)和高敏C反应蛋白(hs-CRP)等。随访30 d主要不良心脏事件发生率。结果与PCI术前比较,2组PCI术后CK-MB、cTnI和hs CRP均明显升高(P<0.01),但负荷治疗组CK-MB、cTnI和hs-CRP升高水平显著低于标准治疗组(P<0.01)。负荷治疗组心肌损伤标记物升高发生率较标准治疗组显著降低(7.3%vs 32.5%,P=0.003;24.4%vs 47.5%,P=0.030)。负荷治疗组主要不良心脏事件发生率较标准治疗组低(2.4% vs 22.5%,P=0.01 61),心肌梗死发生率下降(2.4%vs20.0%,P=0.0307)。结论 NSTEACS患者PCI术前应用阿托伐他汀负荷剂量,能减少PCI术对患者造成的心肌损伤及炎性反应,还可降低PCI术后不良心脏事件的发生,而且安全有效。
Objective To investigate the effect of atorvastatin loading on perioperative period in patients with non-ST-elevation acute coronary syndrome (NSTEACS). Methods A total of 81 patients with NSTEACS were randomly divided into load treatment group (n = 41) and standard treatment group (n = 40). Load-treatment group received atorvastatin 80 mg twice daily before PCI and atorvastatin 40 mg . The elbow venous blood was collected before and 8 and 24 h after operation in both groups. Serum CK-MB, cTnI and hs-CRP were measured. Follow-up 30 d The incidence of major adverse cardiac events. Results Compared with those before PCI, the levels of CK-MB, cTnI and hs-CRP were significantly increased in both groups after PCI (P <0.01), but the levels of CK-MB, cTnI and hs-CRP were significantly lower Treatment group (P <0.01). The incidence of increased myocardial injury markers in the stress-treated group was significantly lower than in the standard treatment group (7.3% vs 32.5%, P = 0.003; 24.4% vs 47.5%, P = 0.030). The incidence of major adverse cardiac events was lower in the load-treated group than in the standard treatment group (2.4% vs 22.5%, P = 0.0161), and the incidence of myocardial infarction was decreased (2.4% vs20.0%, P = 0.0307). Conclusions The application of atorvastatin loading dose before PCI in NSTEACS patients can reduce the myocardial injury and inflammatory reaction in patients with PCI and reduce the incidence of adverse cardiac events after PCI, which is safe and effective.