术前应用不同种类他汀负荷对老年患者PCI围术期的疗效对比

Effect of preoperative application of different statins on elderly patients with PCI during perioperative period

目的观察分析经皮冠状动脉介入术(PCI)术前应用不同种类的负荷量他汀类药物对老年非ST段抬高型急性冠脉综合征(NSTEACS)患者的疗效。方法将连续213例诊断为NSTEACS并行PCI术的老年患者(≥60岁)随机分为4组,阿托伐他汀常规剂量组(A组,55例)、阿托伐他汀负荷剂量组(B组,51例)、瑞舒伐他汀常规剂量组(C组,53例)、瑞舒伐他汀负荷剂量组(D组,54例)。观察比较四组患者术后的血清肌钙蛋白I(cTNI)、血清肌酐(sCr)等指标的变化,术后造影剂肾病(CIN)、主要心脏不良事件(MACE)的发生率。结果术后四组患者cTNI、CK-MB均较术前明显升高(P<0.05)。负荷剂量组升高幅度明显低于常规剂量组(P<0.05),且D组最低(P<0.05);术后四组sCr与术前比较明显升高(P<0.05),eGFR明显下降(P<0.05),负荷剂量组比常规剂量组术后变化幅度小(P<0.05),且B组小于D组(P<0.05)。四组术后CIN发生率分别为21.8%、19.6%、3.8%、5.6%(P=0.006),术后6个月MACE发生率分别为25.5%、5.9%、18.9%、5.6%(P=0.005),负荷剂量组明显低于常规剂量组(P<0.05)。结论老年NSTEACS患者PCI围术期短期应用阿托伐他汀80 mg、瑞舒伐他汀20 mg治疗较常规剂量能减少围术期心肌损伤,更好地保护肾功能,降低CIN及MACE发生率。

Objective To observe and analyze the effect of different kinds of statins before pereutaneous coro- nary intervention （PCI） on elderly patients with non-ST-segment-elevation acute coronary syndrome （NSTEACS）. Methods A total of 213 elderly patients （over 60 years） diagnosed with NSTEACS who received parallel PCI were randomly divided into 4 groups, including atorvastatin conventional dose group （ group A, n = 55 ）, atorvastatin loading dose group（ group B, n = 51 ）, rosuvastatin conventional dose group （ group C, n = 53 ）, and rosuvastatin loading dose group（ group D, n = 54 ）. The changes in troponin I （cTNI） and serum creatinine （ sCr）, and the incidence of congas media-induced nephropathy（ CIN）, and main adverse cardiac events （MACE） were observed and compared. Results The cTNI and CK-MB in four groups were significantly higher than those before operation （ P 〈 0. 05 ）. The increase in loading dose groups was significantly lower than that of conventional dose groups （ P 〈 0. 05 ）, and group D was the lowest （ P 〈 0. 05 ）. After operation, the sCr was significantly higher and eGFR was significantly lower in the four groups （ P 〈 0. 05 ）. Loading dose groups were significantly lower than those of conventional dose groups （ P 〈 0. 05 ）, and group B was lower than group D （P 〈0. 05）. The incidence of CIN was 21.8% ,19. 6% ,3. 8% and 5.6% （P = 0. 006） in the four groups after PCI,and the incidence of major adverse cardiac events was 25.5% ,5.9% ,18. 9% and 5.6% （P =0. 005 ） in the four groups at 6 months after PCI, and loading dose groups were significantly lower than those of conventional dose groups （ P 〈 0. 05 ）. Conclusion Short-term application of atorvastatin 80 rag and rosuvas- tatin 20 mg in perioperative period to elderly NSTEACS patients with PCI can reduce the perioperative myocardial inju- ry. orotect renal function, and decrease the incidence of CIN and MACE comoared with conventional dose.