阿托伐他汀钙预治疗在急性冠状动脉综合征患者PCI术中的应用价值

摘要

目的 探讨阿托伐他汀钙预治疗在急性冠状动脉综合征(ACS)患者皮冠状动脉介入术(PCI)中的应用价值.方法 随机选取拟行PCI术ACS患者80例,随机分为治疗组(n=40)与对照组(n=40).其中对照组患者为首次进行PCI治疗且术前未应用他汀类药物,治疗组患者在术前连续口服阿托伐他汀钙片3个月以上,对两组患者术前、术后12h、24h心肌损伤标记物的变化以及炎性反应进行监测,同时观察患者术后20min靶血管前向血流的TIMI血流分级情况,两组患者术后均随访1个月记录心血管事件的发生情况.结果 与对照组比较,治疗组血清总胆固醇、甘油三酯水平明显低于对照组,差异有统计学意义(均P ＜0.05).与对照组比较,治疗组PCI术前、术后12h及24h的超敏C反应蛋白、白细胞介素-6、肌酸激酶同工酶、心肌肌钙蛋白均低于对照组(均P＜0.05).治疗组PCI术前及术后的TMPG及TIMI血流分级均优于对照组(P＜0.05).治疗组术中无复流现象的发生率明显低于对照组(P＜0.05).治疗组术后1个月内心血管事件发生率明显低于对照组(P＜0.05).结论 阿托伐他汀钙预治疗在ACS患者PCI术中的应用不仅可以减轻患者心肌的损伤,降低炎性反应,还能在一定程度上改善患者术后血流灌注并降低近期心血管事件的发生率.%Objective To explore the value of atorvastatin calcium pre-treatment in patients with acute coronary syndrome (ACS) undergoing percutaneous coronary intervention (PCI).Methods 80 patients with acute coronary syndrome were randomly and equally allocated into treated group (n =40) and control group (n =40).The treated group was given atorvastatin calcium for 3 month before PCI while the other group was treated by PCI for the first time and without statins pre-treatment.The inflanmatory reaction and changes of myocardial injury markers were monitored at different time points (before PCI and 12 h and 24 h after PCI).TIMI flow grading of target vessel antegrade flow at 20 min after PCI was observed.The incidence of major adverse cardiovascular events (MACE) was followed up after PCI for 1 month.Results Compared with the control group,the levels of serum total cholesterol and triglyceride were significantly lower in treated group than those in control group (all P ＜ 0.05).The levels of cTnT,CK-MB,IL-6 and hs-CRP were lower in treated group than those in control group before PCI and at 12 h and 24 h after PCI (all P ＜ 0.05).TIMI flow grading and TMPG flow grading were better in treated group than those in control group (all P ＜ 0.05).The incidence of nonreflow during PCI was lower in treated group than that in control group (P ＜ 0.05).The incidence of MACE was significantly lower in treated group than that in control group (P ＜ 0.05) 1 month after PCI.Conclusions Atorvastatin calcium pre-treatment can not only alleviate myocardial injury and inflammatory reaction,but also improve postoperative blood perfusion to a certain extent and reduce short-term incidence of MACE in ACS patients.