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目的探讨不稳定型心绞痛患者PCI围术期应用阿托伐他汀剂量的选择方案及应用效果。方法择取平顶山市第二人民医院2012年6月至2014年9月收治的行择期PCI的不稳定型心绞痛患者68例,随机分成两组,均接受阿托伐他汀治疗,其中对照组推行常规剂量(术前后均为20mg/d),实验组予以高剂量(术前、术后依次为80、40mg/d),对比两组心血管不良事件发生状况及血栓弹力图测定结果,并分析察围手术期炎性因子[hs-CRP(高敏C反应蛋白)、s VCAM-1(可溶性血管细胞黏附因子)、s CD40L(可溶性CD40配体)、MMP-2(基质金属蛋白酶)]变化情况。结果实验组术后12h hs-CRP:(7.84±1.72)mg/Lvs(8.12±1.82)mg/L、s VCAM-1:(2912.03±672.05)ng/m Lvs(3373.02±697.01)ng/m L、s CD40L:(8973.05±1786.06)ng/m L vs(9375.03±1635.04)ng/m L、MMP-2:(902.07±124.01)μg/L vs(943.03±125.01)μg/L明显低于对照组,差异有统计学意义(P<0.05);两组术后24h及术后3d TXA2抑制药物、ADP受体抑制药物对患者的血小板抑制率及并发症发生率比较差异无统计学意义(P>0.05)。结论预防性应用强化剂量的阿托伐他汀可缓解PCI术后心肌炎症反应,改善患者预后,临床上应引起足够重视。
Objective To investigate the perioperative application of atorvastatin in patients with unstable angina pectoris and its therapeutic effect. Methods Sixty-eight patients with unstable angina pectoris who underwent PCI during June 2012 to September 2014 in Pingdingshan Second People’s Hospital were randomly divided into two groups, all of which were treated with atorvastatin, of which the control group (Preoperative and postoperative 20mg / d), the experimental group was given high dose (preoperative and postoperative 80, 40mg / d), the incidence of adverse cardiovascular events and thromboelastometry results were compared between the two groups Changes of perioperative inflammatory cytokines (hs-CRP, sVCAM-1, sCD40L and soluble matrix metalloproteinase-2) . Results After operation, the hs-CRP in the experimental group was (7.84 ± 1.72) mg / L vs (8.12 ± 1.82) mg / L and s VCAM-1 was (2912.03 ± 672.05) ng / m Lvs (3373.02 ± 697.01) ng / , SCD40L: (8973.05 ± 1786.06) ng / m L vs (9375.03 ± 1635.04) ng / m L, MMP-2: (902.07 ± 124.01) μg / L vs (943.03 ± 125.01) μg / L was significantly lower than that of the control group (P <0.05). There was no significant difference in the rate of platelet inhibition and the incidence of complications between TXA2 inhibitor and ADP receptor antagonist at 24h and three days after operation (P> 0.05). Conclusions The prophylactic use of booster doses of atorvastatin can relieve the myocardial inflammatory response after PCI and improve the prognosis of patients. Clinicians should pay enough attention to it.