瑞舒伐他汀预处理对STEMI患者PPCI后心肌再灌注及迷走神经功能的作用

Impact of pre-administration of rosuvastatin on level of myocardial reperfusion and vagus nerve function after primary PCI in STEMI patients

目的探讨术前瑞舒伐他汀不同预处理对长期服用他汀药物的急性ST段型抬高心肌梗死(STEMI)直接直接经皮冠状动脉介入治疗(PPCI)患者心肌再灌注及迷走神经功能的影响。方法按是否起病前服用他汀类药物超过3个月,将170例首次STEMI患者分为长期他汀干预组、大剂量组和常规剂量组。术前、术后分别检测肌酸激酶同工酶MB(CK-MB)、肌钙蛋白T(TnT)、超敏C反应蛋白(hs-CRP)、白细胞介素-6(IL-6)及血脂水平;评价心肌再灌注情况;术后7、40d检测心率减速力(DC)、化学反射敏感性(ChRS);术后40d内观察主要心血管不良事件及药物不良反应的发生。结果术后TIMI TMPG 3级,RA(室速、窦缓、房室传导阻滞)发生,心电图抬高ST回落率术后及再灌注心律失常方面,长期他汀干预组与大剂量组均明显优于常规剂量组(P<0.05);术后7、40d时,两组DC值、低风险值比例和ChRS值均较常规剂量组明显升高(P<0.05),高风险值比例均较常规剂量组明显降低(P<0.05)。在再发心绞痛、心力衰竭、严重室性心律失常(多形性室性早搏、非持续性室性心动过速)、心脏彩超左室射血分数指标方面,两组均优于常规剂量组(P<0.05)。结论长期服用他汀药物病史患者术前瑞舒伐他汀10mg预处理,即可进一步提高STEMI患者PPCI后心肌再灌注水平,增加迷走神经活性,改善近期预后。

Objective To investigate the impact of different rosuvastatin pretreatments on myocardial reperfusion and vagus nerve function in the patients with ST-segment elevation myocardial infarction（STEMI）taking long term administration of statins undergoing primary percutaneous coronary intervention（PPCI）.Methods According to whether taking statins drugs for over 3months,170 patients suffered from STEMI for the first time were divided into the long term statins intervention group（n=45）、high dose pretreatment group（n=64）and conventional dose pretreatment group（n=61）.CK-MB,TnT,hs-CRP,IL-6and lipids levels were detected before and after PCI.The myocardial reperfusion situation was evaluated.The deceleration capacity of rate（DC）and chemoreflex sensitivity（ChRS）were measured on postoperative 7,40 d.The occurrence of major adverse cardiovascular events（MACE）and adverse drug reactions were observed within postoperative 40 d.Results The long-term statins intervention group was significantly superior to the conventional dose group in the aspects of postoperative TIMI TMPG grade 3,RA（ventricular tachycardia,sinus bradycardia,atrioventricular block）occurrence,EKG elevated ST falling rate and reperfusion arrhythmia（P〈0.05）;the DC value,low-risk value proportion and ChRS value on postoperative 7,40 din the two groups were significantly increased compared with the conventional dose group（P〈0.05）,the high-risk value proportion was significantly decreased compared with the conventional dose group（P〈0.05）.These two groups were superior to the conventional dose group in the aspects of angina pectoris reoccurrence,heart failure,severe ventricular arrhythmia（multiform PVC,non-sustained ventricular tachycardia）and color Doppler ultrasound LVEF.Conclusion Preoperative rosuvastatin 10 mg pre-treatment in the STEMI patients with long-term rosuvastatin administration can further increase the myocardial reperfusion level and vagal nervous activity,and improves the shortterm prognosis.