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目的:观察并探讨急性冠状动脉综合症(ACS)患者支架植入基础上,应用不同剂量瑞舒伐他汀治疗ACS支架植入术后心脏保护作用临床疗效。方法:收集2014-03-2015-01收治的137例ACS患者,其中男78例、女59例,年龄28~87岁,平均(61±4.7)岁。137例患者随机分为:①常规治疗组(对照组):45例患者给予拜阿司匹林、氯吡格雷、硝酸酯类、β受体阻滞剂等常规药物治治疗;②瑞舒伐他汀常规剂量治疗组:45例患者在常规治疗组基础上+每日睡前口服瑞舒伐他汀,剂量为10mg,1次/d;③瑞舒伐他汀大剂量治疗组:47例患者在常规治疗组基础上+睡前口服瑞舒伐他汀,剂量为20mg,1次/d。疗程均为12周,于疗程1周、6周、12周后复查超声心动图与心电图,超敏C反应蛋白(hs-CRP)、脑钠肽前体(pro-BNP)水平,判定治疗效果,各组间心率与超声影像学判定指标如:左心室舒张期末内径(LVEDD)、左心室收缩期末内径(LVESD)、左心室舒张末期容积(LVEDV)、左心室收缩末期容积(LVESV)和左室射血分数(LVEF)。结果:治疗1周后,3组患者空腹静脉血检测hs-CRP、pro-BNP水平、超声心动指标比较,差异均无统计学意义;6周后,瑞舒伐他汀大剂量治疗组患者hsCRP、pro-BNP水平明显低于瑞舒伐他汀常规剂量治疗组(P<0.05)及常规治疗组(P<0.05),而超声心动指标变化无明显差异;治疗12周后,瑞舒伐他汀大剂量治疗组患者hs-CRP、pro-BNP水平明显低于瑞舒伐他汀常规剂量治疗组(P<0.05)及常规治疗组(P<0.05),超声心动指标变化差异明显(P<0.05)。各组随访期间均未发生血栓栓塞与再狭窄。结论:急诊PCI术后3个月睡前加服大剂量瑞舒伐他汀可延缓粥样硬化的进程,有效抑制心脏恶性重塑,改善左心室收缩功能,降低不良事件发生率,明显改善远期预后,临床效果显著。
OBJECTIVE: To observe and discuss the clinical effect of cardioprotection after ACS stenting with different dosages of rosuvastatin on the basis of stent implantation in patients with acute coronary syndrome (ACS). Methods: A total of 137 ACS patients were enrolled from 2014-03-2015-01, including 78 males and 59 females, ranging in age from 28 to 87 years with an average of (61 ± 4.7) years. 137 patients were randomly divided into: ① conventional treatment group (control group): 45 patients given aspirin, clopidogrel, nitrates, β-blockers and other conventional drug treatment; ② rosuvastatin conventional dose Treatment group: 45 patients on the basis of the conventional treatment group + daily oral administration of rosuvastatin, a dose of 10mg, 1 / d; ③ rosuvastatin high-dose treatment group: 47 patients in the conventional treatment group based On + bedtime oral rosuvastatin, a dose of 20mg, 1 / d. The duration of treatment was 12 weeks. Echocardiography and electrocardiogram, hs-CRP and pro-BNP levels were determined at 1 week, 6 weeks and 12 weeks after treatment. The therapeutic effect was evaluated , Heart rate and ultrasound imaging indicators such as left ventricular end diastolic diameter (LVEDD), left ventricular end systolic diameter (LVESD), left ventricular end-diastolic volume (LVEDV), left ventricular end systolic volume (LVESV) Room ejection fraction (LVEF). Results: After 1 week of treatment, the levels of hs-CRP and pro-BNP in fasting venous blood were not significantly different between the three groups. After 6 weeks, the hsCRP, Pro-BNP levels were significantly lower than rosuvastatin conventional dose treatment group (P <0.05) and conventional treatment group (P <0.05), while there was no significant difference in echocardiographic parameters; after 12 weeks treatment, rosuvastatin high dose The levels of hs-CRP and pro-BNP in the treatment group were significantly lower than those in the conventional dose rosuvastatin treatment group (P <0.05) and the conventional treatment group (P <0.05), and the echocardiographic parameters were significantly different (P <0.05). Thromboembolism and restenosis did not occur during follow-up in each group. Conclusions: 3 months after emergency PCI, high-dose rosuvastatin can delay the process of atherosclerosis before going to bed, effectively inhibit cardiac remodeling, improve left ventricular systolic function, reduce the incidence of adverse events and significantly improve the long-term Prognosis, clinical effect is remarkable.