Objective To analyze the effects of intensive and conventional statin therapy combined with lipid-lowering drugs on postprandial 4 h blood lipid and myocardial revascularization in patients with acute myocardial infarction.Methods A total of 150 acute myocardial infarction patients undergoing selective percutaneous coronary intervention from March 2015 to March 2017 in First Hospital of Qinhuangdao were randomly divided into observation group (75 cases) and control group (75 cases).Based on routine antiplatelet,anticoagulant and heart rate control therapies,patients in observation group took atorvastatin 40 mg and ezetimibe 10 mg,1 time/d;the control group took atorvastatin 20 mg and ezetimibe 10 mg,1 time/d.All patients had echocardiography examination before treatment and 6 months after discharge,and they were tested fasting and postprandial 4 h blood lipid before and 1 week after treatment.Postoperative intensive care unit(ICU) stay time and hospital stay time were recorded.Major adverse cardiovascular events were observed during 6 months of follow-up.Results There were no significant differences of age,sex,histories of diabetes mellitus,hypertension,dyslipidemia,smoking,drinking,angina pectoris,onset to treatment time and Killip cardiac function grade between groups (P ＞ 0.05).Levels of fasting blood lipid and postprandial 4 h blood lipid before treatment had no significant differences between groups (P ＞0.05).One week after treatment,fasting blood lipid in observation group showed no significant difference compared to that in control group;levels of postprandial 4 h total cholesterol,triacylglycerol and low-density lipoprotein cholesterol in observation group were significantly lower,and level of high-density lipoprotein cholesterol was significantly higher than those in control group[(3.87 ± 0.84) mmol/L vs (4.92 ± 0.93) mmol/L,(2.06 ±0.05)mmol/L vs (2.17 ± 0.07) mmol/L,(2.13 ± 0.65) mmol/L vs (2.94 ± 0.61) mmol/L,(1.93 ±0.01) mmol/L vs (1.46 ± 0.01) mmol/L] (P ＜ 0.05).Echocardiogram indexes had no significant differences between groups before treatment(P ＞0.05).After 6 months of follow-up,left ventricular end-diastolic dimension in observation group was significantly lower and left ventricular ejection fraction was significantly higher than those in control group [(4.54 ± 0.11) cm vs (5.43 ± 0.34) cm,(68 ± 6) ％ vs (58 ± 1) ％] (P ＜ 0.05).Postoperative ICU stay time and hospital stay time showed no significant differences between groups (P ＞ 0.05).No adverse cardiovascular events occurred in hospital and during follow-up.Conclusion Compared with conventional dose of statin,intensive statin therapy is more effective in lowering postprandial 4 h blood lipid and promoting heart function recovery after myocardial revascularization in treatment of acute myocardial infarction.%目的 探讨强化剂量他汀联合其他降脂药与常规剂量他汀联合降脂药对急性心肌梗死患者餐后4h血脂以及心肌血运重建的影响.方法 将秦皇岛市第一医院2015年3月至2017年3月收治的150例择期行冠状动脉介入治疗的急性心肌梗死患者完全随机分为观察组(75例)和对照组(75例),根据病情分别给予抗血小板、抗凝、控制心率等药物治疗,观察组患者人院当日起给予阿托伐他汀40 mg每晚1次口服,依折麦布10 mg 1次/d口服;对照组患者入院当日起给予阿托伐他汀20 mg每晚1次口服,依折麦布10 mg 1次/d口服.治疗前均行超声心动图检查,检测空腹血脂和餐后4h血脂,记录2组患者冠状动脉介入术后重症监护病房(ICU)监护时间、术后住院时间,治疗1周后复查空腹和餐后4h血脂,患者出院后随访6个月,记录主要心血管不良事件发生情况,并复查超声心动图.结果 ①2组患者治疗前年龄、性别、糖尿病史、高血压史、吸烟史、饮酒史、心绞痛史、发病时间、心功能Killip分级等比较差异均无统计学意义(均P ＞0.05).②2组患者入院时空腹和餐后4h血脂比较差异均无统计学意义(均P＞0.05);经过1周的联合降脂治疗后,观察组的空腹血脂与对照组比较差异均无统计学意义(均P ＞0.05),餐后4h总胆固醇、三酰甘油以及低密度脂蛋白胆固醇明显低于对照组[(3.87±0.84) mmol/L比(4.92±0.93) mmol/L、(2.06±0.05) mmol/L比(2.17-±0.07) mmol/L、(2.13±0.65) mmol/L比(2.94±0.61) mmol/L],而高密度脂蛋白胆固醇明显高于对照组[(1.93 ±0.01)mmol/L比(1.46±0.01)mmol/L],差异均有统计学意义(均P＜0.05).③2组患者人院时超声心动图各指标比较差异均无统计学意义(均P＞0.05),术后6个月随访时,观察组左心室舒张末期内径明显小于对照组[(4.54 ±0.11)cm比(5.43±0.34) cm],左心室射血分数高于对照组[(68±6)％比(58±1)％],差异均有统计学意义(均P ＜0.05).④观察组与对照组冠状动脉介入术后的ICU监护时间、术后住院时间比较差异均无统计学意义(均P＞0.05).⑤2组患者住院和随访期间均未发生主要心血管不良事件.结论 与常规剂量他汀联合降脂药相比较,强化他汀联合降脂药治疗急性心肌梗死患者餐后4h血脂更低,心肌血运重建后的心功能更好.
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