强化阿托伐他汀治疗在慢性心绞痛患者PCI围手术期的应用

Application of enhanced atorvastatin therapy in patients with chronic angina pectoris during perioperative period of PCI

目的 探讨强化阿托伐他汀治疗在慢性心绞痛患者经皮冠状动脉介入治疗(PCI)围手术期的应用效果。方法 行PCI治疗的慢性心绞痛患者225例随机分为三组,每组75例。A组PCI术前3 d开始给予阿托伐他汀20 mg,每天1次,至出院或术后第10天;B组PCI术前3 d开始给予阿托伐他汀80 mg,每天1次,至出院或术后第10天;C组PCI术前3 d开始给予阿托伐他汀20 mg,每天1次,至出院或术后第10天,术前12 h给予阿托伐他汀80 mg,术前2 h给予阿托伐他汀40 mg。术前及术后检测血脂、炎性指标和心肌损伤标记物,观察术后临床不良事件的发生情况。结果 术后72 h,三组TC、LDL-C均较术前降低(P<0.05),超敏C反应蛋白较术前升高(P<0.05),但组间比较无统计学差异(P>0.05)。术后12 h,三组肌红蛋白较术前升高(P<0.05)。术后随访1个月,A组再发心绞痛8例,B组和C组各有2例再发心绞痛,B组和C组发生率低于A组(2.7%和2.7%vs.10.7%)(P<0.05)。结论 慢性心绞痛患者PCI围手术期强化阿托伐他汀治疗,能够改善血脂,减少PCI术后不良心血管事件的发生。

Objective To investigate the application efficacy of enhanced atorvastatin therapy in the patients with chronic angina pectoris during perioperative period of percutaneous coronary intervention(PCI).Methods A total of 225 patients with chronic angina pectoris undergoing PCI were randomly divided into three groups with 75 cases each.Atorvastatin 20 mg was given once a day started 3 days before PCI until discharge or 10 days after surgery in group A.Atorvastatin 80 mg was given once a day started 3 days before PCI until discharge or 10 days after surgery in group B.Atorvastatin 20 mg was given once a day started 3 days before PCI until discharge or 10 days after surgery, and additional atorvastatin 80 mg was given 12 hours before surgery and atorvastatin 40 mg was given 2 hours before surgery in group C.Serum lipids, inflammatory indexes and markers of myocardial injury were detected before and after operation.The incidence of postoperative clinical adverse events was observed.Results The levels of TC and LDL-C were lower and high-sensitivity C-reactive protein was higher 72 hours after PCI than those before in three groups(P<0.05),which were not significantly different among the three groups(P>0.05).The myohemoglobin of three groups was higher 12 hours after PCI than those before(P<0.05).The patients were followed up for one month, which showed that the incidence of recurrent angina pectoris in group A was 10.7%(8/75),which was higher than 2.7%(2/75) in groups of B and C(P<0.05).Conclusion Enhanced atorvastatin therapy in the patients with chronic angina pectoris during perioperative period of PCI can improve the blood lipids and reduce the incidence of adverse cardiovascular events after PCI.