心血管康复医学杂志
心血管康複醫學雜誌
심혈관강복의학잡지
JOURNAL OF CARDIOVASCULAR REHABILITATION MEDICINE
2014年
4期
455-458
,共4页
许丰强%郭俊杰%林培林%安毅%李夏
許豐彊%郭俊傑%林培林%安毅%李夏
허봉강%곽준걸%림배림%안의%리하
心肌梗塞%血管成形术,经腔,经皮冠状动脉%替罗非班%瑞舒伐他汀
心肌梗塞%血管成形術,經腔,經皮冠狀動脈%替囉非班%瑞舒伐他汀
심기경새%혈관성형술,경강,경피관상동맥%체라비반%서서벌타정
Myocardial infarction%Angioplasty,transluminal,percutaneous coronary%Tirofiban%Rosuvastatin
目的：观察和分析替罗非班联合大剂量他汀治疗急性心肌梗死（AMI）的疗效及安全性，评价其对心肌灌注及心脏功能的影响。方法：2011年5月至2013年1月就诊时超出急诊 PCI 时间窗（≥12h），且胸痛缓解或无加重的 AMI 患者共97例，均持续泵入替罗非班48h，根据联合瑞舒伐他汀的剂量分为大剂量组（52例，20mg，1次/d口服，持续服药至梗塞后1月，改为常规剂量10mg，1次/d）和常规剂量组（45例，10mg，1次/d 口服）。全部患者经过保守治疗后于7～10d 行择期 PCI 治疗，比较两组间心肌灌注水平、术后1周和梗塞后30d 心脏功能，酶学改变[肌酸磷酸激酶（CK），乳酸脱氢酶（LDH）]及住院期间主要不良心血管事件（MACE）。结果：与常规剂量组比较，大剂量组梗死相关血管内血栓积分[（1.32±1.01）分比（0.81±0.78）分]、校正的 TIMI 帧数[（32.4±4.73）帧比（26.8±2.34）帧]显著减少（P ＝0.021，P ＜0.001）；择期 PCI 术后大剂量组心肌梗死溶栓试验（TIMI）血流明显优于常规剂量组（P ＝0.024）。大剂量组术后1周左室射血分数（LVEF）明显高于常规剂量组[（51.4±8.9）％比（47.7±8.7）％，P ＝0.021]；术后7d 及30d，两组 CK、LDH 水平均无明显差异（P ＞0.05）。术后住院期间和30d 两组患者均未出现 MACE。结论：替罗非班联合大剂量他汀治疗急性心肌梗死安全、有效，能降低冠脉内的血栓负荷，改善心肌组织灌注和心脏功能，而不增加主要不良心血管事件。
目的：觀察和分析替囉非班聯閤大劑量他汀治療急性心肌梗死（AMI）的療效及安全性，評價其對心肌灌註及心髒功能的影響。方法：2011年5月至2013年1月就診時超齣急診 PCI 時間窗（≥12h），且胸痛緩解或無加重的 AMI 患者共97例，均持續泵入替囉非班48h，根據聯閤瑞舒伐他汀的劑量分為大劑量組（52例，20mg，1次/d口服，持續服藥至梗塞後1月，改為常規劑量10mg，1次/d）和常規劑量組（45例，10mg，1次/d 口服）。全部患者經過保守治療後于7～10d 行擇期 PCI 治療，比較兩組間心肌灌註水平、術後1週和梗塞後30d 心髒功能，酶學改變[肌痠燐痠激酶（CK），乳痠脫氫酶（LDH）]及住院期間主要不良心血管事件（MACE）。結果：與常規劑量組比較，大劑量組梗死相關血管內血栓積分[（1.32±1.01）分比（0.81±0.78）分]、校正的 TIMI 幀數[（32.4±4.73）幀比（26.8±2.34）幀]顯著減少（P ＝0.021，P ＜0.001）；擇期 PCI 術後大劑量組心肌梗死溶栓試驗（TIMI）血流明顯優于常規劑量組（P ＝0.024）。大劑量組術後1週左室射血分數（LVEF）明顯高于常規劑量組[（51.4±8.9）％比（47.7±8.7）％，P ＝0.021]；術後7d 及30d，兩組 CK、LDH 水平均無明顯差異（P ＞0.05）。術後住院期間和30d 兩組患者均未齣現 MACE。結論：替囉非班聯閤大劑量他汀治療急性心肌梗死安全、有效，能降低冠脈內的血栓負荷，改善心肌組織灌註和心髒功能，而不增加主要不良心血管事件。
목적：관찰화분석체라비반연합대제량타정치료급성심기경사（AMI）적료효급안전성，평개기대심기관주급심장공능적영향。방법：2011년5월지2013년1월취진시초출급진 PCI 시간창（≥12h），차흉통완해혹무가중적 AMI 환자공97례，균지속빙입체라비반48h，근거연합서서벌타정적제량분위대제량조（52례，20mg，1차/d구복，지속복약지경새후1월，개위상규제량10mg，1차/d）화상규제량조（45례，10mg，1차/d 구복）。전부환자경과보수치료후우7～10d 행택기 PCI 치료，비교량조간심기관주수평、술후1주화경새후30d 심장공능，매학개변[기산린산격매（CK），유산탈경매（LDH）]급주원기간주요불양심혈관사건（MACE）。결과：여상규제량조비교，대제량조경사상관혈관내혈전적분[（1.32±1.01）분비（0.81±0.78）분]、교정적 TIMI 정수[（32.4±4.73）정비（26.8±2.34）정]현저감소（P ＝0.021，P ＜0.001）；택기 PCI 술후대제량조심기경사용전시험（TIMI）혈류명현우우상규제량조（P ＝0.024）。대제량조술후1주좌실사혈분수（LVEF）명현고우상규제량조[（51.4±8.9）％비（47.7±8.7）％，P ＝0.021]；술후7d 급30d，량조 CK、LDH 수평균무명현차이（P ＞0.05）。술후주원기간화30d 량조환자균미출현 MACE。결론：체라비반연합대제량타정치료급성심기경사안전、유효，능강저관맥내적혈전부하，개선심기조직관주화심장공능，이불증가주요불양심혈관사건。
Objective:To observe and analyze the therapeutic effect and safety of tirofiban combined large dose statin in patients with acute myocardial infarction (AMI),and evaluate its influence on myocardial perfusion and cardiac function.Methods:A total of 97 consecutive AMI patients visited to our hospital from May 2011 to January 2013, who were beyond the emergency PCI time window (≥12h),their chest pain was remissive or not further aggravated were studied.All patients were pumped with tirofiban for 48h continuously;according to combined rosuvastatin dose,they were divided into large dose group (n = 52,20mg,once/d,until one month after infarction,then changed to routine dose of 10mg,once/d)and routine dose group (n=45,10mg,once/d).All patients received se-lective PCI after 7 ~ 10d conservative treatment.Myocardial perfusion level,left ventricular ejection fraction (LVEF)on one week after PCI and 30d after AMI,enzymology changes [creatine (CK),lactate dehydrogenase (LDH)]and major adverse cardiovascular events (MACE)during hospitalization were compared between two groups.Results:Compared with routine dose group,there were significant reductions in thrombus scores in infarct related artery (IRA)[(1.32±1.01)scores vs.(0.81±0.78)scores]and corrected TIMI frame [(32.4±4.73)vs. (26.8±2.34)]in large dose group (P =0.021,P <0.001);after selective PCI,TIMI flow of large dose group was significantly better than that of routine dose group (P =0.024).On one week after PCI,LVEF:(51.4±8.9)% of large dose group was significantly higher than that of routine dose group (47.7±8.7)%,P =0.021;there were no significant difference in levels of CK and LDH between two groups on 7d and 30d after PCI (P >0.05).There was no MACE in both groups during hospitalization and 30d after PCI.Conclusion:Tirofiban combined large dose statin is safe and effective in patients with acute myocardial infarction,it can reduce intra-coronary thrombus burden,im-prove myocardial tissue perfusion and cardiac function without increasing MACE.
