急性ST段抬高型心肌梗死患者急诊经皮冠状动脉介入术前应用负荷剂量阿托伐他汀的疗效观察

Observation on Efficacy of Loading Dose Atorvastatin in Treatment of ST-segment Elevation Myocardial Infarction Before Emergency Percutaneous Coronary Intervention

目的:探讨急诊经皮冠状动脉介入(percutaneous coronary intervention,PCI)术前应用负荷剂量阿托伐他汀对急性ST段抬高型心肌梗死(ST-segment elevation myocardial infarction,STEMI)患者的临床疗效。方法:选取丹江口市第一医院108例拟行急诊PCI术的STEMI患者,根据手术顺序将其编号,奇数者纳入对照组(54例),偶数者纳入观察组(54例)。对照组患者术后常规应用阿托伐他汀,观察组患者术前应用负荷剂量阿托伐他汀+术后常规应用阿托伐他汀。比较2组患者手术前后超敏C反应蛋白(hs-CRP)、B型钠酸肽(BNP)、基质金属蛋白酶9(MMP-9)、左心室射血分数(LVEF)等指标水平及主要不良心血管事件发生率。结果:术后1个月,观察组患者hs-CRP、BNP、MMP-9水平均显著低于对照组,差异均有统计学意义(P<0.05);术后3个月,观察组患者LVEF水平显著优于对照组,差异有统计学意义(P<0.05);观察组患者主要不良心血管事件发生率为3.70%(2/54),显著低于对照组的14.81%(8/54),差异有统计学意义(P<0.05)。结论:急诊PCI术前应用负荷剂量阿托伐他汀,可有效缓解STEMI患者炎症反应程度,改善患者心肌功能,降低主要不良心血管事件发生率。

OBJECTIVE： To probe into the clinical efficacy of loading dose atorvastatin in treatment of ST-segment elevation myocardial infarction（ STEMI） before emergency percutaneous coronary intervention（ PCI）. METHODS： 108 STEMI patients accepting emergency PCI in the First Hospital of Danjiangkou were selected,according to the operation sequence,odd number was set as the control group（ 54 cases）,even number was set as the observation group（ 54 cases）.The control group were treated with atorvastatin as conventional treatment after operation,while the observation group were given loading dose atorvastatin before operation and atorvastatin as conventional treatment after operation. The hs-CRP,BNP,MMP-9 and LVEF and incidence of major adverse cardiovascular events of two groups were observed. RESULTS：After operation of 1 month,the level of hs-CRP,BNP,MMP-9 in observation group were significantly lower than that of control group,with statistically significant difference（ P〈0. 05）. After treatment of 3 months,the level of LVEF in observation group was significantly higher than that of control group,with statistically significant difference（ P〈0. 05）. The incidence of adverse cardiovascular events of observation group was 3. 70%（ 2 /54）,significantly lower than that of control group[14. 81%（ 8 /54） ],with statistically significant difference（ P〈0. 05）. CONCLUSIONS： Application of loading doses atorvastatin before emergency PCI can effectively alleviate the inflammation degree,improve cardiac function and reduce the incidence of adverse cardiovascular events in patients with STEMI.