不同他汀类药物治疗ICU急性心肌梗死患者的效果对比

Comparison of effects of different statins on patients with acute myocardial infarction in ICU

目的比较不同他汀类药物治疗重症监护病房(ICU)急性心肌梗死患者的临床效果。方法抽取2018年2月至2021年7月南阳市第一人民医院收治的急性心肌梗死患者123例,按照随机数字表法分为A、B、C三组,每组41例。A组给予辛伐他汀治疗,B组给予阿托伐他汀治疗,C组给予瑞舒伐他汀治疗。比较三组心功能、血脂水平、载脂蛋白水平、颈动脉内膜-中层厚度(cIMT)及不良反应发生情况。结果治疗后,三组左室射血分数、血管内皮依赖血管舒张功能高于治疗前,且C组增高幅度高于A、B组(P<0.05)。治疗后,三组总胆固醇、三酰甘油、低密度脂蛋白胆固醇低于治疗前,高密度脂蛋白胆固醇高于治疗前,且C组改善幅度优于A、B组(P<0.05)。治疗后,三组载脂蛋白A1高于治疗前,载脂蛋白B低于治疗前,且C组改善幅度优于A、B组(P<0.05)。治疗后,三组左、右cIMT低于治疗前,且C组降低幅度高于A、B组(P<0.05)。三组均未见严重药物不良反应,A、B组出现劳力后胸闷各1例,经积极控制血压后运动平板试验呈阴性。结论辛伐他汀、阿托伐他汀、瑞舒伐他汀应用于ICU急性心肌梗死治疗中,均可一定程度改善患者的心功能和血脂水平,且瑞舒伐他汀效果更显著,临床可结合患者个体情况科学选择他汀类药物,确保治疗效果的最大化。

Objective To compare the clinical effects of different statins on patients with acute myocardial infarction in intensive care unit(ICU).Methods A total of 123 patients with acute myocardial infarction admitted to Nanyang First People’s Hospital from February 2018 to July 2021 were selected,and the patients were divided into group A,B,and C according to random number table method,with 41 cases in each group.Group A was treated with simvastatin,group B was treated with atorvastatin,and group C was treated with rosuvastatin.The cardiac function,the level of blood lipid and apolipoprotein,carotid intima-media thickness(cIMT)and adverse reactions were compared among the three groups.Results After treatment,the left ventricular ejection fraction and flow mediated dilatation in the three groups were higher than those before treatment,and increase of these indexes in the group C were higher than those in the group A and the group B(P<0.05).After treatment,the total cholesterol,triacylglycerol,and low-density lipoprotein cholesterol in the three groups were lower than those before treatment,and the high-density lipoprotein cholesterol in the three groups were higher than those before treatment,and the improvement of the indicators in the group C were better than those of the group A and the group B(P<0.05).After treatment,the apolipoprotein A1 of the three groups were higher than those before treatment,the apolipoprotein B of the three groups were lower than those before treatment,and the improvement in these indexes in the group C were better than those in the group A and the group B(P<0.05).After treatment,the left and right cIMT of the three groups were lower than those before treatment,and the reduction of these indexes in the group C were higher than those in the group A and the group B(P<0.05).There was no severe adverse drug reactions in the three groups.Both group A and group B had 1 case of chest tightness after exertion,and the exercise treadmill test was negative after active blood pressure control.Conclusions Simvastatin,atorvastatin,and rosuvastatin can improve cardiac function and blood lipid levels to a certain extent in the treatment of acute myocardial infarction in ICU,and the effect of rosuvastatin is more significant.Doctors can choose statins scientifically based on the individual conditions of patients to ensure the maximum therapeutic effect.