强化他汀治疗对经皮冠状动脉介入治疗的心脏保护研究

The cardiac protection research of Intensive statin for percutaneous coronary intervention

目的探讨择期行经皮冠状动脉介入治疗（PCI）的急性冠脉综合征患者,术前给予强化阿托伐他汀治疗,以加强对心脏的保护作用。方法选取择期行PCI的急性冠脉综合征患者68例,将患者分为强化组和对照组,每组34例患者。强化组每日口服阿托伐他汀20mg的基础上术前6-8小时顿服阿托伐他汀80mg,术后40mg/d,共30天,之后长期口服阿托伐他汀20mg维持。对照组每日口服阿托伐他汀20mg,术前和术后24小时查超敏C反应蛋白（hs-CRP）、磷酸肌酸激酶同工酶（CKMB）和肌钙蛋白I（c Tn I）。术后1周查肝酶和心肌酶谱,同时随访术后30天心血管不良事件。结果强化组和对照组术后24小时的hs-CRP、CKMB和c Tn I与术前相比均有显著升高。强化组术前和术后24小时的hs-CRP、CKMB和c Tn I较对照组显著下降。强化组30天内不良心血管事件共0例,对照组共2例,差异有显著性（P〈0.05）。结论急性冠脉综合征患者择期行PCI术后炎症因子和心肌酶增高,术前给予阿托伐他汀80mg强化治疗有可能通过降低炎症因子水平,减轻心肌损伤,进一步减少30天主要心血管不良事件,且未发现严重不良反应。

Objective Explore acute coronary syndrome patients who suffer elective percutaneous coronary intervention treatment with preoperative given intensive atorvastatin to study its protective effect on the heart. Method The68 patients,in heart line of our hospital from January 2012 to December 2012,suffer elective PCI with acute coronary syndrome. Patients were divided into strengthening group and control group,34 patients in each group. Patients in strengthening have orally atorvastatin 20 mg a day on the basis of preoperative six to eight hours and take atorvastatin 80 mg. Patients take atorvastatin 40 mg a day for 30 days and take atorvastatin 20 mg a day continuded.The control group take orally atorvastatin 20 mg a day,and exsanguinate assay High-sensitivity C – reactive protein（ hs-CRP）,phosphocreatine（ CKMB） and cardiac troponin I at preoperative and postoperative 24 hours. After a week,they need to exsanguinate assay liver enzyme and myocardial enzyme spectrum,and check PCI postoperative follow-up 30 days,heart blood vessel of adverse events at the same time. Result After 24 hours the strengthening group and control group,the hs CRP,CKMB and c Tn I compared with preoperative condition both elevated significantly. Patients in strengthening group,preoperative and postoperative 24 hours of the hs CRP,CKMB and c Tn I are dropped significantly. strengthening group has adverse cardiovascular events no case 30 days and control group had2 cases. There are significant difference. Conclusion Acute coronary syndrome patients undergo elective PCI postoperative inflammatory factor increasing. Elective PCI preoperative given atorvastatin 80 mg suit can probably reduce the level of inflammatory factors and cardial enzymes,reduce myocardial injured,and reduce major cardiovascular adverse events within 30 days,and no serious adverse reactions.