围术期强化瑞舒伐他汀钙治疗对急性ST段抬高型心肌梗死介入术后的影响

Influence of intensive treatment of rosuvastatin calcium in perioperative period on prognosis of patients with acute ST-segment elevation myocardial infarction undergoing primary PCI

目的探讨围术期强化瑞舒伐他汀钙对急性ST段抬高型心肌梗死(STEMI)急诊冠状动脉介入治疗(PCI)预后的影响。方法搜集2013年8月至2014年8月期间,同意接受急诊介入治疗的STEMI患者85例,随机分为他汀强化组45例和对照组40例。他汀强化组在手术前30 min内开始服用瑞舒伐他汀钙20 mg,连续服用7 d,20 mg/d,之后以10 mg/d长期维持。对照组在急诊手术以前不服用任何他汀类药物,只在手术完成以后开始服用瑞舒伐他汀钙10 mg/d长期维持。比较两组治疗后的血清磷酸肌酸激酶同工酶(CK-MB)、心肌肌钙蛋白I(c TNI)、N末端-前体B型利钠肽(NT-pro BNP)、高敏C反应蛋白(hs-CRP)水平、冠脉内即刻血流以及超声心动图情况。结果他汀强化组中慢血流和无复流的发生率分别为17.8%和6.7%,较对照组的27.5%和15.0%有所降低,但差异无统计学意义(P均>0.05);c TNI(3.9±1.8)μg/L、CK-MB(122.9±15.0)U/L、hs-CRP(4.3±1.3)mg/L、NT-pro BNP(2 645±534)pg/L均低于对照组的(4.8±2.2)μg/L、(155.8±21.0)U/L、(5.3±1.6)mg/L、(3 554±626)pg/L,两组相比有统计学差异(P均<0.05)。而超声心动图中的左室射血分数、左室舒张末期容积、短轴缩短率、室间隔厚度和左房内径两组相比差异无统计学意义(P均>0.05)。结论 STEMI患者瑞舒伐他汀钙PCI围术期强化治疗,可降低血清炎症、心肌坏死指标,改善超声心动图心功能指标;能否对术后即刻慢血流和无复流的发生率产生有统计学意义的降低,有待扩大样本量进一步研究。

Objective To investigate the effects of intensive treatment of rosuvastatin calcium in perioperative period in patients with acute ST segment elevation myocardial infarction （STEMI） undergoing primary percutaneous coronary inter- vention （PCI）. Methods Eighty-five patients with STEMI received primary PCI from August 2013 to August 2014 were enrolled in this study, and they were randomly divided into observation group（ n = 45 ） and control group（ n = 40）. The patients in observation group began to take 20 mg of rosuvastatin calcium within 30rain before PCI and continued to take 20 mg of rosuvastatin calcium everyday for seven days after operation, then turned to take 10 mg of rosuvastatin calcium every- day for long-term maintenance. The patients in control group didht take any statins drugs before operation and only began to take 10 mg of rosuvastatin calcium everyday after operation for long-term maintenance. After operation, the serum levels of ereatine phosphokinase-isoenzyme-MB （CK-MB）, cardie troponin I（ cTNI）, N-terminal pro-B type natriuretic peptide （NT- proBNP） , high sensitivity C-reactive protein （hs-CRP） , coronary immediate blood flow and echocardiogram were compared between two groups. Results The incidences of slow-flow and no-reflow in observation group reduced to some extent compared with control group （ 17.8% vs 27.5% ;8.9% vs 15.0% ） ,but there were no statistical differences between them （all P 〉 0. 05 ）. The levels of cTNI, CK-MB, hs-CRP, NT-proBNP in observation group were significantly lower than those in control group [（3.9±1.8） μg/Lvs （4.8±2.2） μg/L,（122.9 ±15.0） U/Lvs （155.8 ±21.0） U/L,（4.3 ±1.3） mg/L vs （5.3 ± 1.6） mg/L, （2 645 ±534） pg/L vs （3 554 ±626） pg/L,all P 〈0.05]. There were no significant differ- ences in left ventrieular ejection fraction,left ventrieular end-diastolic volume,left ventrieular fractional shortening, inter- ventricular septal thickness and left atrial diameter between two groups （ all P 〉 0.05 ）. Conclusions For the patients with acute STEMI undergoing prima13, PCI, the intensive therapy of rosuvastatin calcium in perioperative period can decrease lev- els of serum inflammation index and myocardial necrosis index and improve heart functions. It should be further expanded sample size to study on whether it can significantly reduce the ineidences of postoperational immediate slow-flow and no-re- t]ow.