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目的探讨术前瑞舒伐他汀不同预处理对急性ST段型抬高心肌梗死(STEMI)直接经皮冠状动脉介入治疗(PCI)患者心肌再灌注和相关因素的影响。方法按是否起病前服用他汀类药物超过3个月,将170例首次STEMI患者随机分为长期干预组45例、大剂量组64例和常规剂量组61例。术前、术后分别检测肌酸激酶同功酶(CK-MB)、肌钙蛋白(TnT)、超敏C反应蛋白(hs-CRP)、白介素-6(IL-6)及血脂水平;测定左室射血分数(LVEF),评价心肌再灌注情况;术后40天内观察主要心血管不良事件及药物不良反应的发生。结果 PCI术后长期干预组患者CK-MB、TnT峰值水平、hsCRP、IL-6值、心肌灌注水平与大剂量组比较无显著差异,2组均较常规剂量组明显改善(P均<0.05)。2组再发心绞痛、心力衰竭、严重室性心律失常发生率较常规剂量组明显降低,而LVEF则明显升高(P均<0.05)。结论 STEMI PCI患者长期或大剂量服用他汀药物较术前常规剂量预处理,可进一步提高患者心肌灌注,保护心肌,减少严重心律失常的发生。
Objective To investigate the effect of pretreatment with rosuvastatin on myocardial reperfusion and related factors in patients with acute ST-segment elevation myocardial infarction (STEMI) undergoing direct percutaneous coronary intervention (PCI). Methods According to whether to take statins for more than 3 months before onset, 170 patients with first STEMI were randomly divided into long-term intervention group (n = 45), high-dose group (n = 64) and conventional dose group (n = 61). The levels of CK-MB, TnT, hs-CRP, IL-6 and serum lipids were measured before and after surgery respectively. Left ventricular ejection fraction (LVEF), evaluation of myocardial reperfusion; observed within 40 days after major adverse cardiovascular events and adverse drug reactions. Results There was no significant difference in the levels of CK-MB, TnT, hsCRP, IL-6 and myocardial perfusion between long-term intervention group and high-dose group after PCI. Both groups were significantly improved compared with conventional dose group (all P < . The incidence of recurrent angina pectoris, heart failure and severe ventricular arrhythmia in the two groups were significantly lower than those in the conventional dose group, while LVEF was significantly increased (all P <0.05). Conclusions Long-term or high-dose statin treatment in patients with STEMI PCI pretreatment than conventional preoperative dose can further improve myocardial perfusion, protect myocardium and reduce the incidence of severe arrhythmia.