CAJ | 학술논문

　　目的观察急性ST段抬高型心肌梗死患者急诊冠状动脉介入治疗（PCI）围术期使用负荷量阿托伐他汀的疗效及安全性。方法对2009-03-2010-03行急诊PCI的33例急性ST段抬高型心肌梗死患者，确诊后立即给予阿托伐他汀80mg负荷剂量，经绿色通道完成急诊PCI术后予以阿托伐他汀40mg/d继续治疗1个月，观察负荷量阿托伐他汀的疗效和安全性。结果 PCI术后血流再灌注情况（如TIMI血流等级、无复流现象发生情况、ST段水平回落情况及心肌酶谱峰值情况等）结果令人满意；除1例患者因肺部感染、呼吸衰竭转入ICU经积极救治无效死亡外，无围术期心肌梗死、靶血管重建及支架内血栓等主要心脏不良事件的发生；全程观察肝肾功能等药物安全性指标，30d时血碱性磷酸酶、肌酐和尿素氮水平与入院当天相比差异均无统计学意义（均P＞0.05），30d时测AST、ALT分别为（27.50±8.69）、（23.63±8.03）U/L，均在正常参考值范围内，与入院当天相比明显下降（均P＜0.01）。结论对于急性ST段抬高型心肌梗死拟急诊行PCI治疗的患者，围术期使用负荷量阿托伐他汀不仅安全而且疗效令人满意。
　　목적관찰급성ST단태고형심기경사환자급진관상동맥개입치료（PCI）위술기사용부하량아탁벌타정적료효급안전성。방법대2009-03-2010-03행급진PCI적33례급성ST단태고형심기경사환자，학진후립즉급여아탁벌타정80mg부하제량，경록색통도완성급진PCI술후여이아탁벌타정40mg/d계속치료1개월，관찰부하량아탁벌타정적료효화안전성。결과 PCI술후혈류재관주정황（여TIMI혈류등급、무복류현상발생정황、ST단수평회락정황급심기매보봉치정황등）결과령인만의；제1례환자인폐부감염、호흡쇠갈전입ICU경적겁구치무효사망외，무위술기심기경사、파혈관중건급지가내혈전등주요심장불량사건적발생；전정관찰간신공능등약물안전성지표，30d시혈감성린산매、기항화뇨소담수평여입원당천상비차이균무통계학의의（균P＞0.05），30d시측AST、ALT분별위（27.50±8.69）、（23.63±8.03）U/L，균재정상삼고치범위내，여입원당천상비명현하강（균P＜0.01）。결론대우급성ST단태고형심기경사의급진행PCI치료적환자，위술기사용부하량아탁벌타정불부안전이차료효령인만의。
Objective To investigate the efficacy and safety of perioperative loading- dose atorvastatin in patients with a-cute ST- segment elevation myocardial infarction. Methods Thirty three patients with acute ST- segment elevation myocardial infarction admitted from March 2010 to March 2012 were included in the study. Emergency percutaneous coronary intervention (PCI) was performed immediately after administration of 80mg loading dose atorvastatin, then 40mg/d atorvastatin was given after the emergency PCI and continued for 1 month. The efficacy and safety of high- dose atorvastatin loading were observed. Re-sults Blood reperfusion indicators, including TIMI flow grade, reflow, ST levels drop and myocardial enzyme spectrum after PCI were satisfactory. No periprocedural MI, target vessel revascularization,stent thrombosis and other major adverse cardiac events occurred, except one patient with pulmonary infection and respiratory failure who were transferred to ICU and dead. The blood alkaline phosphatase, creatinine and urea nitrogen levels were not changed after 30d of admission (P>0.05). The AST and ALT levels after 30d were lower than those at admission(P<0.01) and returned to normal range. Conclusion Perioperative high- dose atorvastatin loading is safe and effective for patients with acute ST- segment elevation myocardial infarction undergoing emer-gency PCI.