CAJ | 학술논문

心肌梗死%血管成形术,经腔,经皮冠状动脉%心率%自主神经系统%心律失常,心性%冠状动脉介入术%心率变异性%恶性室性心律失常%阿托伐他汀心肌梗死%血管成形術,經腔,經皮冠狀動脈%心率%自主神經繫統%心律失常,心性%冠狀動脈介入術%心率變異性%噁性室性心律失常%阿託伐他汀
심기경사%혈관성형술,경강,경피관상동맥%심솔%자주신경계통%심률실상,심성%관상동맥개입술%심솔변이성%악성실성심률실상%아탁벌타정
myocardial infarction%angioplasty,transluminal,percutaneous coronary%heart rate%autonomic nervous system%ar-rhythmias,cardiac%PCI%heart rate variability%malignant ventricular arrhythmia%Atorvastatin

目的：探讨大剂量阿托伐他汀（80 mg/d）对急诊冠状动脉介入（PCI）术后早期心率变异性(HRV)及恶性室性心律失常（MVA）的影响。方法将350例行急诊PCI治疗的急性心肌梗死（AMI）患者随机均分为大剂量他汀组（大剂量组）和常规剂量他汀组（常规剂量组），另设对照组85例。大剂量组入院立即口服阿托伐他汀80 mg/d，第2天起改为40 mg/d，常规剂量组入院立即口服阿托伐他汀40 mg/d，第2天起改为20 mg/d。术后24 h连续行动态心电图（Holter）检测，并根据Holter结果比较各组HRV及MVA发生率。结果大剂量组和常规剂量组SDNN（ms：108.3±21.5、70.6±17.6）、SDANN（ms：111.7±19.2、65.9±18.5）、RMSSD（ms：25.6±8.3、18.7±10.2）和PNN50（%：14.7±5.9、6.9±3.4）均低于正常对照组（分别为122.5±23.8、119.6±15.2、29.2±9.3及17.7±6.5），大剂量组高于常规剂量组（均P＜0.05）。大剂量组和常规剂量组MVA发生率均高于正常对照组（12.00%vs 21.14%vs 2.35%），大剂量组低于常规剂量组（χ2=5.29，P＜0.05）。结论 AMI患者梗死早期HRV减低，MVA发生率增加；大剂量阿托伐他汀能够增加急诊PCI术后早期HRV，并降低MVA发生率。
목적：탐토대제량아탁벌타정（80 mg/d）대급진관상동맥개입（PCI）술후조기심솔변이성(HRV)급악성실성심률실상（MVA）적영향。방법장350례행급진PCI치료적급성심기경사（AMI）환자수궤균분위대제량타정조（대제량조）화상규제량타정조（상규제량조），령설대조조85례。대제량조입원립즉구복아탁벌타정80 mg/d，제2천기개위40 mg/d，상규제량조입원립즉구복아탁벌타정40 mg/d，제2천기개위20 mg/d。술후24 h련속행동태심전도（Holter）검측，병근거Holter결과비교각조HRV급MVA발생솔。결과대제량조화상규제량조SDNN（ms：108.3±21.5、70.6±17.6）、SDANN（ms：111.7±19.2、65.9±18.5）、RMSSD（ms：25.6±8.3、18.7±10.2）화PNN50（%：14.7±5.9、6.9±3.4）균저우정상대조조（분별위122.5±23.8、119.6±15.2、29.2±9.3급17.7±6.5），대제량조고우상규제량조（균P＜0.05）。대제량조화상규제량조MVA발생솔균고우정상대조조（12.00%vs 21.14%vs 2.35%），대제량조저우상규제량조（χ2=5.29，P＜0.05）。결론 AMI환자경사조기HRV감저，MVA발생솔증가；대제량아탁벌타정능구증가급진PCI술후조기HRV，병강저MVA발생솔。
Objective To study the influence of high dose atorvastatin (80 mg/d) in early heart rate variability and malignant ventricular arrhythmia in patients underwent emergency coronary intervention (PCI). Methods A total of 350 pa-tients underwent emergency PCI were randomly divided into two groups:high dose atorvastatin group and regular dose atorv-astatin group. And 85 cases of control were enrolled randomly. The patients using high dose atorvastatin group received atorv-astatin 80 mg orally STAT upon hospitalization and 40 mg once a day from the second day. The patients using regular dose atorvastatin group received atorvastatin 40 mg orally STAT after hospitalization and 20 mg once a day from the second day. Patients were monitored by continuous dynamic electrocardiogram for 24 hours after PCI. According to the results of dynamic electrocardiogram, the early heart rate variability (HRV) and rate of malignant ventricular arrhythmia (MVA) were measured and compared between three groups. Results The values of standard deviation of all normal sinus RR intervals over 24 h (SDNN) were(108.3 ± 21.5)ms and(70.6 ± 17.6)ms for high dose atorvastatin group and regular dose atorvastatin group re-spectively. The values of SDNN measured every 5 minutes during 24 hours (SDANN) were (111.7 ± 19.2)ms and (65.9 ± 18.5)ms respectively, and values of root-mean-square of successive normal sinus RR interval difference (RMSSD) were (25.6±8.3)ms and(18.7±10.2)ms respectively, and the percentage of adjacent RR intervals that differed by more than 50 ms (PNN50) were(14.7±5.9)%and(6.9±3.4)%for high dose atorvastatin group and regular dose atorvastatin group respec-tively. The above data were significantly lower than those in control group [ (122.5±23.8) ms and (119.6±15.2) ms, (29.2±9.3) ms and (17.7±6.5)%, P<0.05]. There were significantly higher values in high dose atorvastatin group than those in regular dose atorvastatin group (P<0.05). The incidence rate of MVA was much higher in high dose atorvastatin group and regular dose atorvastatin group than that in normal control group (12.00%vs 21.14%vs 2.35%). The incidence rate of MVA was sig-nificantly lower in high dose atorvastatin group than that in regular dose atorvastatin group (χ2=5.29, P<0.05). Conclu-sion The HRV was significantly reduced and the incidence rate of MVA was much higher in patients with early AMI. High-dose atorvastatin can increase the HRV and decrease the incidence rate of MVA in patients underwent emergency PCI.