中国医药
中國醫藥
중국의약
China Medicine
2015年
10期
1413-1417
,共5页
周发展%宋兆峰%刘即芳%张焕轶%尹鲁骅
週髮展%宋兆峰%劉即芳%張煥軼%尹魯驊
주발전%송조봉%류즉방%장환질%윤로화
瑞舒伐他汀%替罗非班%心肌梗死%经皮冠状动脉介入治疗%心肌再灌注损伤
瑞舒伐他汀%替囉非班%心肌梗死%經皮冠狀動脈介入治療%心肌再灌註損傷
서서벌타정%체라비반%심기경사%경피관상동맥개입치료%심기재관주손상
Rosuvastatin%Tirofiban%Myocardial infarction%Percutaneous coronary intervention%Myocardial reperfusion injury
目的 探讨急诊经皮冠状动脉介入治疗(PCI)术前负荷瑞舒伐他汀和应用替罗非班对PCI相关心肌再灌注损伤及预后的影响.方法 选择2012年4月至2014年1月于山东省泰安市中心医院接受急诊PCI治疗的急性心肌梗死患者85例,采用随机数字表法分为观察组(43例)和对照组(42例).观察组术前负荷瑞舒伐他汀20 mg,并冠状动脉推注替罗非班10 μg/kg,继之以0.15 μg/(kg·min)静脉泵入36 h,术后继续服用瑞舒伐他汀10 mg/d,对照组仅于术后服用瑞舒伐他汀10 mg/d.PCI术后分析患者冠状动脉造影结果,进行心肌梗死溶栓治疗(TIMI)血流分级;同时应用酶联免疫吸附法检测2组PCI术前及术后24 h可溶性细胞间黏附分子(sICAM-1)、可溶性血管细胞黏附分子(sVCAM-1)和高敏C反应蛋白(hs-CRP)水平;并记录术后6个月再发心绞痛、心肌梗死、死亡等主要不良心血管事件(MACE)的发生情况.结果 观察组的TIMI 3级血流分级比例明显高于对照组,差异有统计学意义[79.1％(34/43)比50.0％ (21/42),P＜0.0l];术后24h,观察组sICAM-1、sVCAM-1、hs-CRP明显低于对照组[(24.2 ±2.3)μg/L比(37.2±3.3) μg/L、(26.2±2.9)μg/L比(43.3±3.8) μg/L、(8.2±5.0)mg/L比(10.9 ±4.7)mg/L],差异有统计学意义(P＜0.05).观察组和对照组再发心绞痛、心肌梗死发生率差异无统计学意义(P＞0.05).2组无死亡事件发生.结论 急性心肌梗死患者急诊PCI术前负荷瑞舒伐他汀和应用替罗非班可改善TIMI分级,降低PCI相关心肌再灌注损伤,并改善患者预后.
目的 探討急診經皮冠狀動脈介入治療(PCI)術前負荷瑞舒伐他汀和應用替囉非班對PCI相關心肌再灌註損傷及預後的影響.方法 選擇2012年4月至2014年1月于山東省泰安市中心醫院接受急診PCI治療的急性心肌梗死患者85例,採用隨機數字錶法分為觀察組(43例)和對照組(42例).觀察組術前負荷瑞舒伐他汀20 mg,併冠狀動脈推註替囉非班10 μg/kg,繼之以0.15 μg/(kg·min)靜脈泵入36 h,術後繼續服用瑞舒伐他汀10 mg/d,對照組僅于術後服用瑞舒伐他汀10 mg/d.PCI術後分析患者冠狀動脈造影結果,進行心肌梗死溶栓治療(TIMI)血流分級;同時應用酶聯免疫吸附法檢測2組PCI術前及術後24 h可溶性細胞間黏附分子(sICAM-1)、可溶性血管細胞黏附分子(sVCAM-1)和高敏C反應蛋白(hs-CRP)水平;併記錄術後6箇月再髮心絞痛、心肌梗死、死亡等主要不良心血管事件(MACE)的髮生情況.結果 觀察組的TIMI 3級血流分級比例明顯高于對照組,差異有統計學意義[79.1％(34/43)比50.0％ (21/42),P＜0.0l];術後24h,觀察組sICAM-1、sVCAM-1、hs-CRP明顯低于對照組[(24.2 ±2.3)μg/L比(37.2±3.3) μg/L、(26.2±2.9)μg/L比(43.3±3.8) μg/L、(8.2±5.0)mg/L比(10.9 ±4.7)mg/L],差異有統計學意義(P＜0.05).觀察組和對照組再髮心絞痛、心肌梗死髮生率差異無統計學意義(P＞0.05).2組無死亡事件髮生.結論 急性心肌梗死患者急診PCI術前負荷瑞舒伐他汀和應用替囉非班可改善TIMI分級,降低PCI相關心肌再灌註損傷,併改善患者預後.
목적 탐토급진경피관상동맥개입치료(PCI)술전부하서서벌타정화응용체라비반대PCI상관심기재관주손상급예후적영향.방법 선택2012년4월지2014년1월우산동성태안시중심의원접수급진PCI치료적급성심기경사환자85례,채용수궤수자표법분위관찰조(43례)화대조조(42례).관찰조술전부하서서벌타정20 mg,병관상동맥추주체라비반10 μg/kg,계지이0.15 μg/(kg·min)정맥빙입36 h,술후계속복용서서벌타정10 mg/d,대조조부우술후복용서서벌타정10 mg/d.PCI술후분석환자관상동맥조영결과,진행심기경사용전치료(TIMI)혈류분급;동시응용매련면역흡부법검측2조PCI술전급술후24 h가용성세포간점부분자(sICAM-1)、가용성혈관세포점부분자(sVCAM-1)화고민C반응단백(hs-CRP)수평;병기록술후6개월재발심교통、심기경사、사망등주요불양심혈관사건(MACE)적발생정황.결과 관찰조적TIMI 3급혈류분급비례명현고우대조조,차이유통계학의의[79.1％(34/43)비50.0％ (21/42),P＜0.0l];술후24h,관찰조sICAM-1、sVCAM-1、hs-CRP명현저우대조조[(24.2 ±2.3)μg/L비(37.2±3.3) μg/L、(26.2±2.9)μg/L비(43.3±3.8) μg/L、(8.2±5.0)mg/L비(10.9 ±4.7)mg/L],차이유통계학의의(P＜0.05).관찰조화대조조재발심교통、심기경사발생솔차이무통계학의의(P＞0.05).2조무사망사건발생.결론 급성심기경사환자급진PCI술전부하서서벌타정화응용체라비반가개선TIMI분급,강저PCI상관심기재관주손상,병개선환자예후.
Objective To explore the effect of high-loading-dosage of rosuvastatin and tirofiban on myocardial reperfusion injury and prognosis in patients with acute myocardial infarction (AMI) undergoing emergency percutaneous coronary intervention (PCI).Methods Totally 85 patients with AMI undergoing emergency PCI from April 2012 to January 2014 were enrolled and randomly divided into observation group (43 cases) given high-loading-dosage of rosuvastatin (20 mg,oral) and tirofiban [10 μg/kg bolus,then 0.15 μg/(kg · min) infusion for 36 h] before operation,rosuvastatin (10 mg/d) after operation,and control group (42 cases) given rosuvastatin 10 mg/d after operation.The thrombolysis in myocardial infarction (TIMI) flow grade was assessed by coronary angiography at the end of PCI;the plasma concentrations of soluble intercellar adhesion molecules 1 (sICAM-1),soluble vascular cell adhesion molecule l (sVCAM-1) and high sensitivity C reactive protein (hs-CRP) were measured by enzyme-linked immunosorbent assay (ELISA) before and after PCI;the postoperative major adverse cardiac events 6 months after PCI,including recurrence of angina pectoris,myocardial infarction and death,were recorded and compared between the two groups.Results The proportion of TIMI grade 3 in observation group was significantly higher than that in control group [79.1％ (34/43) vs 50.0％ (21/42)] (P ＜ 0.01);24 h after PCI,the levels of sICAM-1,sVCAM-1 and hs-CRP were significantly lower than those in control group [(24.2 ± 2.3) μg/L vs (37.2±3.3) μg/L,(26.2±2.9) μg/L vs (43.3±3.8) μg/L,(8.2±5.0) mg/L vs (10.9±4.7) mg/L] (P ＜ 0.05).Six months after PCI,the incidences of angina pectoris recurrence and myocardial infarction in observation group were not significantly different from those in control group (P ＞ 0.05);no death occurred in both groups.Conclusion Application of high-loading-dose of rosuvastatin and tirofiban before operation can decrease the myocardial tissue perfusion injury and improve the prognosis in AMI patients undergoing emergency PCI.
