瑞舒伐他汀治疗急性ST段抬高型心肌梗死患者经皮冠状动脉介入术后的临床研究  

Clinical trial of rosuvastatin on patients with ST-segment elevation myocardial infarction after percutaneous coronary intervention

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

机构地区：[1]中国人民解放军武汉总医院心血管内科,武汉430070

出　　处：《中国临床药理学杂志》2017年第18期1735-1739,共5页The Chinese Journal of Clinical Pharmacology

基　　金：湖北省科技支撑计划基金资助项目(2014BCH051)

摘　　要：目的探讨术前瑞舒伐他汀不同预处理对长期或未服用他汀药物的急性ST段抬高型心肌梗死(STEMI)直接经皮冠状动脉介入治疗(PCI)患者心肌再灌注和近期疗效的影响。方法将170例STEMI患者按起病前是否服用他汀类药物超过3个月,首先分为长期服用他汀组患者45例(长期他汀干预组)及未长期服用他汀患者125例(起病前未曾服用过或服用时间在3月内者)。将125例未长期服用他汀患者随机分为大剂量预处理组64例和常规剂量预处理组61例。大剂量预处理组于术前30 min给予口服瑞舒伐他汀20 mg,术后继续口服瑞舒伐他汀10 mg qn,共40 d;常规剂量预处理组及长期他汀干预组均于术前30min给予口服瑞舒伐他汀10 mg,术后继续口服瑞舒伐他汀10 mg qn,共40 d。所有受试者PCI术前即刻均给予口服阿司匹林300 mg顿服+氯吡格雷600 mg顿服,术后给予阿司匹林100 mg,qd,长期口服+氯吡格雷75 mg qd,至少12个月。比较3组患者心肌再灌注情况、左心室舒张末期内径(LVEDD)、左室短轴缩短率(FS)、左心室射血分数(LVEF)、主要不良心血管事件和药物不良反应发生情况。结果 PCI术后,长期他汀干预组、大剂量预处理组和常规剂量预处理组心肌再灌注达到TIMI 3级的比例分别为95.56%,93.75%和85.25%;心电图ST段回落率(STR)分别为95.56%,93.75%和86.89%;再灌注心律失常发生率分别为57.78%,60.94%和36.07%,差异均有统计学意义(均P<0.05)。长期他汀干预组、大剂量预处理组和常规剂量预处理组术后40 d时LVEDD分别为(51.88±4.79),(52.80±4.82)和(52.85±4.72)mm,FS分别为(40.05±2.25)%,(39.65±2.89)%和(34.05±2.89)%,LVEF分别为(54.08±6.22)%,(53.78±6.92)%和(47.05±6.10)%,分别与术后7 d的LVEDD、FS、LVEF比较,差异均有统计学意义(均P<0.05)。长期他汀干预组出现的主要心血管不良事件主要有再发心绞痛1例,心源性休克3例,心力衰竭1例,严重室性心律失常2例,心血管不良�Objective To investigate the effect of rosuvastatin on myocardial reperfusion and the recent clinical efficacy of patients with ST-segment elevation myocardial infarction（ STEMI） after primarypercutaneous coronary intervention（ PCI） with/without the chronic pre-treatment of statins. Methods A total of 170 STEMI patients after primary PCI were enrolled. According to the history with the pre-treatment of statins,the patients were divided into long-term intervention group（ pre-treatment of statins more than 3 months,n = 45） and no long-term treatment group（ without pre-treatment of statins or with less than 3 months pre-treatment of statins,n = 125） patients. The no long-term treatment group was then randomly divided into the high dose group（ n = 64） and conventional dose group（ n = 61）. The patients in high dose group were orally given treated with rosuvastatin 20 mg orally before PCI,and treated with rosuvastatin 10 mg qn after PCI,while the patients in the other two groups were treated with 10 mg rosuvastatin orally before PCI,and given rosuvastatin 10 mg qn after PCI. The three groups were treated for 40 d. All patients were orally given aspirin 300 mg ＋ clopidogrel 600 mg before PCI,and treated with aspirin 100 mg qd ＋ clopidogrel 75 mg qd after PCI for at least 12 months. Myocardial reperfusion,left ventricular end-diastolic dimension（ LVEDD）,fractional shortening（ FS） and Left ventricular ejection fraction（ LVEF）,major adverse cardiovascular events（ MACEs） and adverse drug reactions were compared among the three groups. Results In the high dose group,long-term intervention group and the conventional dose group,the rates of TIMI 3 grade were 93. 75%,95. 56% and 85. 25% respectively,while the rates of STR were 93. 75%,95. 56% and 86. 89%,and the incidence of reperfusion arrhythmia was 60. 94%,57. 78% and 36. 07%. Significant differences were found in all the parameters above among all groups（ P〈0. 05）. Forty days after PCI,in the three groups LVEDD were（ 52. 8

关 键 词：瑞舒伐他汀 急性ST段抬高型心肌梗死 再灌注 经皮冠状动脉介入术 

分 类 号：R972[医药卫生—药品]