急诊冠状动脉介入治疗围术期使用负荷量阿托伐他汀的疗效及安全性观察  

Efficacy and safety of perioperative loading-dose atorvastatin in patients with acute ST-segment elevation myocardial infarction

作　　者：徐长福[1] 陆明[1] 车庆[1] 窦丽萍[1] 余希霞[1] 周冰之[1] 张小蓓[1] 黄抒伟[1] 

机构地区：[1]浙江中医药大学附属第二医院心内科,杭州310005

出　　处：《浙江医学》2013年第15期1407-1409,1437,共4页Zhejiang Medical Journal

基　　金：浙江省医学会科研基金项目(2009ZYC17)

摘　　要：目的观察急性ST段抬高型心肌梗死患者急诊冠状动脉介入治疗(PCI)围术期使用负荷量阿托伐他汀的疗效及安全性。方法对2009-03一2010-03行急诊PCI的33例急性ST段抬高型心肌梗死患者,确诊后立即给予阿托伐他汀80mg负荷剂量,经绿色通道完成急诊PCI术后予以阿托伐他汀40mg/d继续治疗1个月,观察负荷量阿托伐他汀的疗效和安全性。结果 PCI术后血流再灌注情况(如TIMI血流等级、无复流现象发生情况、ST段水平回落情况及心肌酶谱峰值情况等)结果令人满意;除1例患者因肺部感染、呼吸衰竭转入ICU经积极救治无效死亡外,无围术期心肌梗死、靶血管重建及支架内血栓等主要心脏不良事件的发生;全程观察肝肾功能等药物安全性指标,30d时血碱性磷酸酶、肌酐和尿素氮水平与入院当天相比差异均无统计学意义(均P>0.05),30d时测AST、ALT分别为(27.50±8.69)、(23.63±803)U/L,均在正常参考值范围内,与入院当天相比明显下降(均P<0.01)。结论对于急性ST段抬高型心肌梗死拟急诊行PCI治疗的患者,围术期使用负荷量阿托伐他汀不仅安全而且疗效令人满意。Objective To investigate the efficacy and safety of perioperative loading- dose atorvastatin in patients with a-cute ST- segment elevation myocardial infarction. Methods Thirty three patients with acute ST- segment elevation myocardial infarction admitted from March 2010 to March 2012 were included in the study. Emergency percutaneous coronary intervention （PCI） was performed immediately after administration of 80mg loading dose atorvastatin, then 40mg/d atorvastatin was given after the emergency PCI and continued for 1 month. The efficacy and safety of high- dose atorvastatin loading were observed. Re-sults Blood reperfusion indicators, including TIMI flow grade, reflow, ST levels drop and myocardial enzyme spectrum after PCI were satisfactory. No periprocedural MI, target vessel revascularization,stent thrombosis and other major adverse cardiac events occurred, except one patient with pulmonary infection and respiratory failure who were transferred to ICU and dead. The blood alkaline phosphatase, creatinine and urea nitrogen levels were not changed after 30d of admission （P〉0.05）. The AST and ALT levels after 30d were lower than those at admission（P〈0.01） and returned to normal range. Conclusion Perioperative high- dose atorvastatin loading is safe and effective for patients with acute ST- segment elevation myocardial infarction undergoing emer-gency PCI.

关 键 词：急性ST段抬高型心肌梗死 负荷量阿托伐他汀 疗效 安全性 

分 类 号：R541.4[医药卫生—心血管疾病]