不同剂量瑞舒伐他汀对急性心肌梗死静脉溶栓后再通患者心功能的影响

Effects of different doses of rosuvastatin on heart function of patients with acute myocardial infarction recanalisated after intravenous thrombolysis

目的观察常规剂量和高剂量瑞舒伐他汀对急性心肌梗死（AMI）静脉溶栓后再通患者心功能的影响，评价其临床疗效和安全性。方法AMI行静脉溶栓后临床判断为再通的患者共45例，将其完全随机分为常规剂量组（22例）和高剂量组（23例）。在常规治疗的基础上，分别在AMI发病24h内开始口服瑞舒伐他汀10mg／d（常规剂量组）和40mg／d（高剂量组）。治疗第1、4和12周末测定左心室射血分数（LVEF）、左心室短轴缩短率（LVFS），第4和12周末行6min步行试验（6-MWT）。结果治疗第12周末，高剂量组的LVEF、LVFS和6-MWT步行距离均明显高于常规剂量组，差异均有统计学意义[（51±10）％比（40±10）％，（29±8）％比（24±6）％，（313±90）m比（242±74）m，均P〈0．05]。2组在治疗过程仅少数患者出现轻度不良反应。结论对AMI静脉溶栓后再通患者在常规治疗的基础上加用高剂量瑞舒伐他汀（40mg／d）早期强化治疗，其心功能的改善优于常规剂量（10mg／a），并且安全性好，值得临床推广。

Objective To detect the effects of different doses of rosuvastatin on heart function of patients with acute myocardial infarction recanalisated after intravenous thrombolysis, and to evaluate the chncal effect and safety. Methods Seventy-six patients with acute myocardial infarction who treated with intravenous thrombolysis were divided into two groups. Based on routine treatment, the patients were given rosuvastatin 10mg/d （routine dose group） and 40mg/d （high dose group） respectively within 2Ah of the disease onset. The LVEF and LVFS were detected at the end of 1,4 and 12 weeks after treatment, and the 6-MWT were detected at the end of 4 and 12 weeks after treatment. Results The LVEF, LVFS and 6-MWT in high dose group at the end of 12 weeks after treatment were all higher than that in routine group [ （51 ± 10） % vs （40 ±10） %, （ 29 ± 8 ） % vs （ 24 ± 6 ） %, （ 313 ± 90） m vs （242 ± 74） m, all P 〈 0. 05 ], There were only a minority of patients showing mild adverse reactions. Conclusion Based on routine treatment, the acute myocardial infarction patients with intravenous thrombolysis receive high dose of rosuvastatin （40 rag/d）, may improve heart function and is better than that of normal dose treatment, and the safetv is good,which made this treatment is worth clinical promotion.