中国中西医结合急救杂志
中國中西醫結閤急救雜誌
중국중서의결합급구잡지
Chinese Journal of Integrated Traditional and Western Medicine in Intensive and Critical Care
2015年
6期
606-610
,共5页
冠心病%瑞舒伐他汀%对比剂肾病%心肌梗死%主要不良心血管事件
冠心病%瑞舒伐他汀%對比劑腎病%心肌梗死%主要不良心血管事件
관심병%서서벌타정%대비제신병%심기경사%주요불양심혈관사건
Coronary artery disease%Rosuvastatin%Contrast induced nephropathy%Myocardial infarction%Major adverse cardiac vascular event
目的：探讨老年冠心病患者行经皮冠状动脉介入术（PCI）治疗前单次负荷剂量瑞舒伐他汀对术后并发症的预防作用。方法将天津市第一中心医院心内科住院并接受PCI手术的216例老年冠心病患者按随机数字表法分为两组，每组108例。一组PCI术前24 h内给予负荷剂量瑞舒伐他汀20 mg（负荷剂量组），另一组PCI术前给予常规剂量瑞舒伐他汀5 mg（常规剂量组），两组患者均在术后口服瑞舒伐他汀5 mg/d；测定两组患者PCI前后血肌酐（SCr）、内生肌酐清除率（CCr）、心肌肌钙蛋白I（cTnI）、肌酸激酶同工酶（CK-MB）及超敏C-反应蛋白（hs-CRP）水平，计算对比剂肾病（CIN）、心肌梗死（心梗）发生率；术后随访1年，观察主要不良心血管事件（MACE）的发生率。结果 PCI术前两组患者SCr、CCr、cTnI、CK-MB、hs-CRP水平比较差异均无统计学意义（均P＞0.05）。两组PCI术后SCr、cTnI、CK-MB、hs-CRP均较术前升高，术后CCr较术前降低，且常规剂量组变化程度较负荷剂量组更显著〔SCr（μmol/L）为89.52±21.79比83.45±19.17，cTnI（μg/L）为0.49±0.23比0.35±0.18，CK-MB（μg/L）为5.98±1.16比3.05±0.71，hs-CRP（mg/L）为8.31±0.06比2.46±0.02， CCr （mL/min）为62.61±19.54比73.48±20.14，均P＜0.05〕；负荷剂量组CIN 〔7.41%（8/108）比17.59%（19/108）〕、心梗发生率〔1.85%（2/108）比8.33%（9/108）〕均明显低于常规剂量组（均P＜0.05）。术后30 d内负荷剂量组MACE发生率明显低于常规剂量组〔5.56%（6/108）比13.89%（15/108），P＜0.05〕，术后1年内MACE发生率负荷剂量组和常规剂量组比较差异无统计学意义〔19.44%（21/108）比27.78%（30/108），P＞0.05〕。结论老年冠心病患者PCI术前应用单次负荷剂量瑞舒伐他汀能保护心肾功能，降低CIN和心梗发生率以及术后近期MACE的发生率。
目的：探討老年冠心病患者行經皮冠狀動脈介入術（PCI）治療前單次負荷劑量瑞舒伐他汀對術後併髮癥的預防作用。方法將天津市第一中心醫院心內科住院併接受PCI手術的216例老年冠心病患者按隨機數字錶法分為兩組，每組108例。一組PCI術前24 h內給予負荷劑量瑞舒伐他汀20 mg（負荷劑量組），另一組PCI術前給予常規劑量瑞舒伐他汀5 mg（常規劑量組），兩組患者均在術後口服瑞舒伐他汀5 mg/d；測定兩組患者PCI前後血肌酐（SCr）、內生肌酐清除率（CCr）、心肌肌鈣蛋白I（cTnI）、肌痠激酶同工酶（CK-MB）及超敏C-反應蛋白（hs-CRP）水平，計算對比劑腎病（CIN）、心肌梗死（心梗）髮生率；術後隨訪1年，觀察主要不良心血管事件（MACE）的髮生率。結果 PCI術前兩組患者SCr、CCr、cTnI、CK-MB、hs-CRP水平比較差異均無統計學意義（均P＞0.05）。兩組PCI術後SCr、cTnI、CK-MB、hs-CRP均較術前升高，術後CCr較術前降低，且常規劑量組變化程度較負荷劑量組更顯著〔SCr（μmol/L）為89.52±21.79比83.45±19.17，cTnI（μg/L）為0.49±0.23比0.35±0.18，CK-MB（μg/L）為5.98±1.16比3.05±0.71，hs-CRP（mg/L）為8.31±0.06比2.46±0.02， CCr （mL/min）為62.61±19.54比73.48±20.14，均P＜0.05〕；負荷劑量組CIN 〔7.41%（8/108）比17.59%（19/108）〕、心梗髮生率〔1.85%（2/108）比8.33%（9/108）〕均明顯低于常規劑量組（均P＜0.05）。術後30 d內負荷劑量組MACE髮生率明顯低于常規劑量組〔5.56%（6/108）比13.89%（15/108），P＜0.05〕，術後1年內MACE髮生率負荷劑量組和常規劑量組比較差異無統計學意義〔19.44%（21/108）比27.78%（30/108），P＞0.05〕。結論老年冠心病患者PCI術前應用單次負荷劑量瑞舒伐他汀能保護心腎功能，降低CIN和心梗髮生率以及術後近期MACE的髮生率。
목적：탐토노년관심병환자행경피관상동맥개입술（PCI）치료전단차부하제량서서벌타정대술후병발증적예방작용。방법장천진시제일중심의원심내과주원병접수PCI수술적216례노년관심병환자안수궤수자표법분위량조，매조108례。일조PCI술전24 h내급여부하제량서서벌타정20 mg（부하제량조），령일조PCI술전급여상규제량서서벌타정5 mg（상규제량조），량조환자균재술후구복서서벌타정5 mg/d；측정량조환자PCI전후혈기항（SCr）、내생기항청제솔（CCr）、심기기개단백I（cTnI）、기산격매동공매（CK-MB）급초민C-반응단백（hs-CRP）수평，계산대비제신병（CIN）、심기경사（심경）발생솔；술후수방1년，관찰주요불양심혈관사건（MACE）적발생솔。결과 PCI술전량조환자SCr、CCr、cTnI、CK-MB、hs-CRP수평비교차이균무통계학의의（균P＞0.05）。량조PCI술후SCr、cTnI、CK-MB、hs-CRP균교술전승고，술후CCr교술전강저，차상규제량조변화정도교부하제량조경현저〔SCr（μmol/L）위89.52±21.79비83.45±19.17，cTnI（μg/L）위0.49±0.23비0.35±0.18，CK-MB（μg/L）위5.98±1.16비3.05±0.71，hs-CRP（mg/L）위8.31±0.06비2.46±0.02， CCr （mL/min）위62.61±19.54비73.48±20.14，균P＜0.05〕；부하제량조CIN 〔7.41%（8/108）비17.59%（19/108）〕、심경발생솔〔1.85%（2/108）비8.33%（9/108）〕균명현저우상규제량조（균P＜0.05）。술후30 d내부하제량조MACE발생솔명현저우상규제량조〔5.56%（6/108）비13.89%（15/108），P＜0.05〕，술후1년내MACE발생솔부하제량조화상규제량조비교차이무통계학의의〔19.44%（21/108）비27.78%（30/108），P＞0.05〕。결론노년관심병환자PCI술전응용단차부하제량서서벌타정능보호심신공능，강저CIN화심경발생솔이급술후근기MACE적발생솔。
Objective To investigate the efficacy of treatment with a single loading dose of rosuvastatin before percutaneous coronary intervention (PCI) for prevention of complications after surgery in elderly patients underwent PCI with coronary artery disease.Methods 216 elderly patients with coronary artery disease admitted to Department of Cardiology of Tianjin First Center Hospital were divided into two groups at random (108 patients per group). Within 24 hours before PCI, the patients of loading dose group received a loading dose of rosuvastatin 20 mg, while the patients of regular dose group received a regular dose of rosuvastatin 5 mg, and after surgery, both groups received rosuvastatin 5 mg/d orally. The serum creatinine (SCr), endogenous creatinine clearance rate (CCr), cardiac Troponin I (cTnI), creatine kinase-MB isoenzyme (CK-MB) and hypersensitive C-reactive protein (hs-CRP) before and after PCI were detected, and the incidences of contrast induced nephropathy (CIN) and myocardial infarction were calculated in both groups. The patients were followed up for 1 year after PCI, and the incidence of major adverse cardiac events (MACE) was observed.Results There were no statistically significant differences in the levels of SCr, CCr, cTnI, CK-MB or hs-CRP before PCI between two groups (allP > 0.05). While after PCI in two groups, the levels of SCr, cTnI, CK-MB and hs-CRP were higher than those before PCI, but CCr was lower than that before PCI, and the changes in regular dose group were more significant as compared with loading dose group [SCr (μmol/L): 89.52±21.79 vs. 83.45±19.17, cTnI (μg/L): 0.49±0.23 vs. 0.35±0.18, CK-MB (μg/L): 5.98±1.16 vs. 3.05±0.71, hs-CRP (mg/L): 8.31±0.06 vs. 2.46±0.02, CCr (mL/min): 62.61±19.54 vs. 73.48±20.14, allP < 0.05]. The incidence of CIN [7.41% (8/108) vs. 17.59 (19/108)] and myocardial infarction [1.85% (2/108) vs. 8.33% (9/108)] in loading dose group was evidently lower than that in regular dose group (bothP < 0.05). The incidence of MACE within 30 days after PCI in loading dose group was lower than that in regular dose group [5.56% (6/108) vs. 13.89% (15/108),P < 0.05], while within 1 year after PCI, the comparison of MACE incidence between loading dose group and regular dose group showed no statistically significant difference [19.44% (21/108) vs. 27.78% (30/108),P > 0.05].Conclusion A single loading dose of rosuvastatin given before PCI in elderly patients with coronary cardiac disease can protect renal function and myocardium, reduce the incidences of CIN, myocardial infarction and the occurrence of MACE at early stage after PCI.
