阿托伐他汀联合左西孟旦对急性心肌梗死合并心力衰竭的疗效

Curative effect of atorvastatin combined with levosimendan on acute myocardial infarction combined with heart failure

目的探究阿托伐他汀联合左西孟旦治疗急性心肌梗死(AMI)合并心力衰竭(心衰)的临床效果。方法以56例AMI合并心衰患者为研究对象,随机分为观察组和对照组,每组28例,2组患者均按照AMI治疗指南给予常规基础治疗,对照组在此基础上给予左西孟旦治疗,观察组在对照组治疗的基础上联合阿托伐他汀治疗,连续治疗1周。观察2组患者的临床疗效,治疗前后的心功能指标、血流动力学指标、心肌损伤指标、血清脑钠肽(BNP)和超敏-C反应蛋白(hs-CRP)水平,并统计治疗过程中不良反应发生情况。结果治疗后观察组临床有效率(92.86%)高于对照组(71.43%),χ^(2)=4.383,P=0.036;治疗后2组患者的心脏指数(CI)、每搏输出量(SV)、左心室射血分数(LVEF)、中心静脉压(CVP)、平均肺动脉压(MPAP)和肺循环阻力(PVR)均显著改善(P<0.05),且治疗后观察组患者的上述指标改善更显著(P<0.05);治疗后2组患者的血清中肌酸激酶(CK)、肌酸激酶同工酶(CK-MB)、心肌肌钙蛋白I(cTnI)、BNP和hs-CRP均显著降低(P<0.05),且治疗后观察组患者上述指标降低更显著(P<0.05);对照组患者的不良反应发生率(7.14%)与观察组(9.68%)比较差异无统计学意义(χ^(2)=0.122,P=0.727)。结论阿托伐他汀联合左西孟旦治疗AMI合并心衰可显著改善其心功能,调节血流动力学,保护心脏,降低机体炎症水平,且安全性高。

Objective To explore the clinical curative effect of atorvastatin combined with levosimendan on acute myocardial infarction(AMI)combined with heart failure(HF).Methods A total of 56 patients with AMI and HF were enrolled and randomly divided into observation group and control group,28 cases in each group.The both groups were given routine basic treatment according to AMI treatment guidelines.On this basis,the control group were treated with levosimendan,while the observation group were treated with oral atorvastatin on the basis of control group.They were continuously treated for 1 week.The clinical curative effect,and the levels of cardiac function indexes,haemodynamics indexes,myocardial injury indexes,serum brain natriuretic peptide(BNP)and high-sensitivity C-reactive protein(hs-CRP)before and after treatment in both groups were observed.The occurrence of adverse reactions during treatment was statistically analyzed.Results After treatment,the clinical response rate of observation group was higher than that of control group(92.86%vs.71.43%)(χ^(2)=4.383,P=0.036).After treatment,the cardiac index(CI),stroke volume(SV),left ventricle ejection fraction(LVEF),central venous pressure(CVP),mean pulmonary artery pressure(MPAP)and pulmonary vascular resistance(PVR)in both groups were significantly improved(P<0.05),whose improvement was more significant in observation group than in control group(P<0.05).After treatment,the serum creatine kinase(CK),creatine kinase MB(CK-MB),cardiac troponin I(cTnI),BNP and hs-CRP in both groups were all significantly decreased(P<0.05),whose decrease was more significant in observation group than in control group(P<0.05).There was no significant difference in the incidence of adverse reactions between control group and observation group(7.14%vs.9.68%)(χ^(2)=0.122,P=0.727).Conclusion Atorvastatin combined with levosimendan can significantly improve cardiac function,regulate haemodynamics,protect heart and reduce the inflammation level in patients with AMI and HF,with high safety.