直接PCI前瑞舒伐他汀干预对长期服用他汀药物老年STEMI病人心肌再灌注及迷走神经功能的作用  

Impact of Pre-administration of Rosuvastatin on the Myocardial Reperfusion and Vagus Nerve Function in Elderly Patients with STEMI by Chronic Pre-treatment of Statins Undergoing Primary PCI

作　　者：卢青[1] 丁世芳[1] 陈志楠[1] 蒋桔泉[1] 龚志刚[1] 李志刚[1] 付文波[1] 

机构地区：[1]广州军区武汉总医院,武汉430070

出　　处：《中西医结合心脑血管病杂志》2016年第24期2857-2863,共7页Chinese Journal of Integrative Medicine on Cardio-Cerebrovascular Disease

基　　金：湖北省科技支撑计划(No.2014BCH051)

摘　　要：目的探讨直接PCI术前瑞舒伐他汀不同预处理对长期服用他汀药物的急性ST段型抬高心肌梗死(STEMI)老年病人心肌再灌注和迷走神经功能的影响。方法按是否起病前服用他汀类药物超过3月,将118例首次STEMI老年病人随机分为长期他汀干预组(32例)、大剂量预处理组(45例)和常规剂量预处理组(41例)。术前、术后分别检测心肌磷酸酶同工酶(CK-MB)、心肌肌钙蛋白T(TnT)、超敏C反应蛋白(hs-CRP)、白介素-6(IL-6)及血脂水平;评价心肌再灌注情况;术后7d、40d检测心率减速力(DC)、化学反射敏感性(ChRS);术后40d内观察主要心血管不良事件及药物不良反应的发生。结果 PCI术后长期他汀干预组病人CK-MB、TnT峰值水平、hs-CRP、IL-6、心肌灌注水平与大剂量组比较无统计学意义,两组均较常规剂量组明显改善(P<0.05);术后7d及40d时,两组DC值、低风险值比例和ChRS值均较常规剂量组明显升高(P<0.05),高风险值比例均较常规剂量组明显降低(P<0.05)。再发心绞痛、心衰、严重室性心律失常(多形性室早、非持续性室性心动过速)、心脏彩超左室射血分数(LVEF)指标方面,两组均优于常规剂量组(P<0.05)。结论长期服用他汀药物病史病人术前常规剂量瑞舒伐他汀预处理,即可进一步提高直接PCI术治疗的老年STEMI病人心肌灌注,保护心肌,增加迷走神经活性,减少严重心律失常的发生,改善近期预后。Objective To compare the level of myocardial reperfusion and vagus nerve function with different previous therapy of rosuvastatin in elderly patients suffered from ST-segment elevation myocardial infarction（STEMI）with the chronic pre-treatment of statins undergoing primary percutaneous coronary intervention（PCI）.Methods One hundred and eighteen consecutive elderly patients suffered from STEMI first time undergoing primary PCI were enrolled.According to the history with the chronic pre-treatment of statins,they were randomly divided into the group with chronic pre-treatment of statins（n =32）,high dose group（n =45）and conventional dose group（n =41）.Creatine kinaseMB（CK-MB）,troponin T（TnT）,hs-CRP,interleukin-6（IL-6）and lipids levels were fested before and after PCI.Myocardial reperfusion was evaluated during PCI.On7 days and40 days after PCI,the deceleration cepacity of rate（DC）and chemoreflex sensitivity（ChRS）were measured.The occurrence of major adverse cardiovascular events and adverse drug reactions were observed within 40 days after PCI.Results The levels of CK-MB,TnT,hs-CRP,IL-6 and,lipids and myocardial reperfusion in the group with chronic pre-treatment of statins and high dose group were significantly better than those in the conventional dose group（P〈0.05）.After PCI,compared with the conventional dose group,the DC,percentages of low-risk patients and ChRS in the group with chronic pre-treatment of statins and high dose group were significantly higher,and percentages of high-risk patients were lower obviously（P〈0.05）.Compared with the conventional dose group,the incidence of angina pectoris post-PCI,heart failure,severe ventricular arrhythmia and LVEF were significantly better in the other two groups（P〈0.05）.Conclusion Conventional dose pre-treatment with rosuvastatin for elderly patients suffered from STEMI with the chronic pre-treatment of statins Conld alleviate the ischemic myocardial reperfusion,protected myocardial,increase vagal activity,reduc

关 键 词：急性ST段抬高型心肌梗死 老年人 他汀 再灌注 迷走神经 经皮冠状动脉介入术 

分 类 号：R542.22[医药卫生—心血管疾病]