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目的:探讨不同剂量阿托伐他汀预处理对行经皮冠状动脉介入治疗(PCI)的非ST段抬高型急性冠脉综合征 (NSTE-ACS)患者的保护作用。方法:选取2014年1月-2016年4月某院收治的NSTE-ACS患者81例,按随机数字表法分为高剂量组(40例)和低剂量组(41例)。高剂量组患者在PCI术前12~24 h给予阿托伐他汀钙片80 mg,术前2 h再给予40 mg;低剂量组患者在PCI术前12~24 h给予阿托伐他汀钙片10 mg。观察两组患者术后血流储备分数 (FFR)、冠脉血流储备分数(CFR)和微循环阻力指数 (IMR),比较两组患者手术前后肌酸激酶(CK)、肌酸激酶同工酶(CK-MB)和高敏感性C反应蛋白(hs-CRP)水平。结果:两组患者术后FFR、CFR比较,差异无统计学意义(P>0.05);高剂量组患者术后IMR显著低于低剂量组,差异有统计学意义(P<0.05)。两组患者术前CK、CK-MB和CRP水平比较,差异无统计学意义(P>0.05);术后,低剂量组患者CK-MB和CRP水平显著升高,且显著高于高剂量组,差异均有统计学意义(P<0.05);两组患者术后CK水平比较,差异无统计学意义(P>0.05)。两组患者均未见明显不良反应发生。结论:在实施PCI术前,对NSTE-ACS患者预先使用高剂量阿托伐他汀(80→40 mg)可显著改善患者微循环障碍,同时抑制炎症反应。
OBJECTIVE: To investigate protective effects of different doses of atorvastatin pretreatment on non-ST-segment elevation acute coronary syndrome (NSTE-ACS) patients underwent percutaneous coronary intervention (PCI). METHODS: A total of 81 NSTE-ACS patients in a hospital during Jan. 2014-Apr. 2016 were divided into high-dose group (40 cases) and low dose group (41 cases) according to random number table. High-dose group was given Atorvastatin calcium tablet 80 mg 12-24 h before PCI, and then 40 mg 2 h before PCI. Low-dose group was given Atorvastatin calcium tablet 10 mg 12-24 h before PCI. Fractional flow reserve (FFR), coronary flow reserve (CFR) and index of microcirculation resistance (IMR) after surgery were all observed in 2 groups. The levels of creatine kinase (CK), creatine kinase myocardial band (CK-MB) and high sensitive C-reactive protein (hs-CRP) were compared between 2 groups before and after surgery. RESULTS: There was no statistical significance in FFR and CFR after surgery between 2 groups (P>0.05); IMR of high-dose group was significantly lower than low-dose group, with statistical significance (P<0.05). There was no statistical significance in CK, CK-MB or CRP between 2 groups before surgery (P>0.05). After surgery, the levels of CK-MB and CRP in low-dose group were significantly higher than high-dose group, with statistical significance (P<0.05). There was no statistical significance in CK level between 2 groups after surgery (P>0.05). No obvious ADR was found in 2 groups. CONCLUSIONS: During PCI, pre-treatment with high-dose of atorvastatin (80→40 mg) could effectively improve microcirculatory disturbance and inhibit inflammatory reaction of NSTE-ACS patients.
急性冠脉综合征经皮冠状动脉介入治疗阿托伐他汀剂量
Acute coronary syndromePercutaneous coronary interventionatorvastatinDose
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