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目的探讨围术期强化瑞舒伐他汀钙对急性ST段抬高型心肌梗死(STEMI)急诊冠状动脉介入治疗(PCI)预后的影响。方法搜集2013年8月至2014年8月期间,同意接受急诊介入治疗的STEMI患者85例,随机分为他汀强化组45例和对照组40例。他汀强化组在手术前30 min内开始服用瑞舒伐他汀钙20 mg,连续服用7 d,20 mg/d,之后以10 mg/d长期维持。对照组在急诊手术以前不服用任何他汀类药物,只在手术完成以后开始服用瑞舒伐他汀钙10 mg/d长期维持。比较两组治疗后的血清磷酸肌酸激酶同工酶(CK-MB)、心肌肌钙蛋白I(c TNI)、N末端-前体B型利钠肽(NT-pro BNP)、高敏C反应蛋白(hs-CRP)水平、冠脉内即刻血流以及超声心动图情况。结果他汀强化组中慢血流和无复流的发生率分别为17.8%和6.7%,较对照组的27.5%和15.0%有所降低,但差异无统计学意义(P均>0.05);c TNI(3.9±1.8)μg/L、CK-MB(122.9±15.0)U/L、hs-CRP(4.3±1.3)mg/L、NT-pro BNP(2 645±534)pg/L均低于对照组的(4.8±2.2)μg/L、(155.8±21.0)U/L、(5.3±1.6)mg/L、(3 554±626)pg/L,两组相比有统计学差异(P均<0.05)。而超声心动图中的左室射血分数、左室舒张末期容积、短轴缩短率、室间隔厚度和左房内径两组相比差异无统计学意义(P均>0.05)。结论 STEMI患者瑞舒伐他汀钙PCI围术期强化治疗,可降低血清炎症、心肌坏死指标,改善超声心动图心功能指标;能否对术后即刻慢血流和无复流的发生率产生有统计学意义的降低,有待扩大样本量进一步研究。
Objective To investigate the effect of perioperative augmentation of rosuvastatin calcium on prognosis of acute coronary intervention (STEMI) with acute myocardial infarction (STEMI). Methods From August 2013 to August 2014, 85 STEMI patients who agreed to receive emergency interventions were randomly divided into statin-intensive group (n = 45) and control group (n = 40). The statin-fortified group started taking 20 mg of rosuvastatin calcium within 30 min before surgery and continued for 7 d and 20 mg / d respectively before long-term maintenance at 10 mg / d. The control group did not take any statin before emergency surgery and started long-term maintenance with rosuvastatin calcium 10 mg / d after the procedure was completed. The serum levels of CK-MB, cTnI, NT-pro BNP, high-sensitivity C reaction Protein (hs-CRP) levels, intra-coronary immediate blood flow and echocardiography. Results The incidences of slow and no-reflows in statin-fortified group were 17.8% and 6.7%, respectively, which were lower than those in the control group (27.5% and 15.0%), but the difference was not statistically significant (all P> 0.05); c The levels of TNI (3.9 ± 1.8) μg / L, CK-MB (122.9 ± 15.0) U / L, hs-CRP (4.3 ± 1.3) mg / L and NT-pro BNP (2 645 ± 534) pg / (4.8 ± 2.2) μg / L, (155.8 ± 21.0) U / L, (5.3 ± 1.6) mg / L and (3 554 ± 626) pg / L in the control group respectively. There was a significant difference between the two groups All <0.05). Echocardiography in left ventricular ejection fraction, left ventricular end-diastolic volume, short axis shortening, interventricular septum thickness and left atrial diameter were no significant difference between the two groups (P all> 0.05). Conclusion STEMI patients with rosuvastatin calcium PCI perioperative intensive treatment, can reduce serum inflammation, myocardial necrosis indicators, to improve echocardiography cardiac function; whether the immediate postoperative slow blood flow and no recurrence of the incidence of The statistical significance of the reduction, pending the expansion of sample size for further study.