阿托伐他汀干预对急性冠状动脉综合征患者PCI术后粘附分子水平的影响

Objective To explore the impact of different dose atorvastatin on the adhesion molecules level in the acute coronary syndrome (ACS) patients who had received percutaneous coronary intervention (PCI). Methods Eighty-eight ACS patients were divided into three groups, group A (normal treatment group), group B (normal treatment plus atorvastatin 10mg per day) and group C (normal treatment plus atorvastatin 80mg per day). The patients in group B received atorvastatin 10 mg per day orally before PCI and after PCI subsequently, and the patients in group C received atorvastatin 80 mg per day orally before PCI and after PCI subsequently for three days, then the dose of atorvastatin was decrease to 10 mg per day. The concentrations of soluble intercellular adhesionmolecule-1 (sICAM-1) and soluble vascular cell adhesion molecule-1 (sVCAM-1) were detected before PCI and at the 3rd, 7th 14th day after PCI. Results At the 7th day, the concentrations of sICAM-1 and sVCAM-1 in group C were significantly lower than those in group B, which showed sICAM-1 (68.35±23.80) μg/L vs (131.45±29.12) μg/L and sVCAM-1 (251. 65±36.61)μg/L vs (334.87±32.98) μg/L, respectively. Compared to group A, the adhesion molecule level in group B and group C were significantly decreased (P<0.05) and had no obviously affect on blood fat level. Conclusion The treatment of atorvastatin could significantly decrease the adhesion molecules' level after PCI, which may play an important role in lowing inflammation and coronary artery restenosis after PCI.     

阿托伐他汀干预对急性冠状动脉综合征患者PCI术后粘附分子水平的影响

Objective To explore the impact of different dose atorvastatin on the adhesion molecules level in the acute coronary syndrome (ACS) patients who had received percutaneous coronary intervention (PCI). Methods Eighty-eight ACS patients were divided into three groups, group A (normal treatment group), group B (normal treatment plus atorvastatin 10mg per day) and group C (normal treatment plus atorvastatin 80mg per day). The patients in group B received atorvastatin 10 mg per day orally before PCI and after PCI subsequently, and the patients in group C received atorvastatin 80 mg per day orally before PCI and after PCI subsequently for three days, then the dose of atorvastatin was decrease to 10 mg per day. The concentrations of soluble intercellular adhesionmolecule-1 (sICAM-1) and soluble vascular cell adhesion molecule-1 (sVCAM-1) were detected before PCI and at the 3rd, 7th 14th day after PCI. Results At the 7th day, the concentrations of sICAM-1 and sVCAM-1 in group C were significantly lower than those in group B, which showed sICAM-1 (68.35±23.80) μg/L vs (131.45±29.12) μg/L and sVCAM-1 (251. 65±36.61)μg/L vs (334.87±32.98) μg/L, respectively. Compared to group A, the adhesion molecule level in group B and group C were significantly decreased (P<0.05) and had no obviously affect on blood fat level. Conclusion The treatment of atorvastatin could significantly decrease the adhesion molecules' level after PCI, which may play an important role in lowing inflammation and coronary artery restenosis after PCI.     

慢性充血性心力衰竭患者联合用药疗效观察

目的观察在常规药物洋地黄、利尿剂、硝酸酯类、血管紧张素转换酶抑制剂(ACEI)依那普利基础上,加用β受体阻制剂美托洛尔及醛固酮拮抗剂螺内酯等联合用药治疗CHF患者的临床疗效及安全性。方法选择慢性CHF患者67例,根据治疗方法不同分成对照组和观察组。结果观察组与对照组的有效率分别为87.9%,58.8%(P<0.0l),CO,SV,EF较对照组明显增加(P<0.0l)。不良反应发生率分别为15.1%,17.6%(P>0.05),即联合用药疗法对心功能的改善明显优于常规药物疗法,不良反应发生率无明显差别(P>0.05)。结论在常规药物洋地黄、利尿剂、硝酸酯类、ACEI类药物基础上加用β受体阻制剂及醛固酮拮抗剂治疗慢性CHF是目前最佳的治疗方法。     

阿托伐他汀干预对急性冠状动脉综合征患者PCI术后粘附分子水平的影响

Objective To explore the impact of different dose atorvastatin on the adhesion molecules level in the acute coronary syndrome (ACS) patients who had received percutaneous coronary intervention (PCI). Methods Eighty-eight ACS patients were divided into three groups, group A (normal treatment group), group B (normal treatment plus atorvastatin 10mg per day) and group C (normal treatment plus atorvastatin 80mg per day). The patients in group B received atorvastatin 10 mg per day orally before PCI and after PCI subsequently, and the patients in group C received atorvastatin 80 mg per day orally before PCI and after PCI subsequently for three days, then the dose of atorvastatin was decrease to 10 mg per day. The concentrations of soluble intercellular adhesionmolecule-1 (sICAM-1) and soluble vascular cell adhesion molecule-1 (sVCAM-1) were detected before PCI and at the 3rd, 7th 14th day after PCI. Results At the 7th day, the concentrations of sICAM-1 and sVCAM-1 in group C were significantly lower than those in group B, which showed sICAM-1 (68.35±23.80) μg/L vs (131.45±29.12) μg/L and sVCAM-1 (251. 65±36.61)μg/L vs (334.87±32.98) μg/L, respectively. Compared to group A, the adhesion molecule level in group B and group C were significantly decreased (P<0.05) and had no obviously affect on blood fat level. Conclusion The treatment of atorvastatin could significantly decrease the adhesion molecules' level after PCI, which may play an important role in lowing inflammation and coronary artery restenosis after PCI.     

射频导管消融治疗特发性室性心动过速及顽固室性早搏

目的探讨特发性室性心动过速（IVT）和顽固性室性早搏（VPC）的射频消融（RFCA）治疗效果及该方法的可行性和必要性。方法对10例左室特发性室速（ILVT）、9例右室流出道室速（IRVT）及22例右室流出道（RVOT）室性早搏、2例左室流出道（LVOT）室性早搏，分别采用激动顺序标测法及起搏标测法行射频消融治疗。结果43例患者术中，总成功率为97．7％，室速成功消融率19／19（100％），室早成功消融率23／24（95．8％），术中、术后均无并发症；术后随访3-40mo，室速无复发，室早消融复发率低1／23（4．3％）。结论射频消融治疗特发性室速或室早是安全、有效且成功率高的一种方法。     

急性冠状动脉综合征患者炎症相关分子水平变化的临床意义

目的观察在不同类型冠心病(CHD)患者血清中,白介素-6(IL-6)、IL-18、C反应蛋白(CRP)、基质金属蛋白酶-2(MMP-2)、单核细胞趋化蛋白-1(MCP-1)等分子水平及血脂变化,探讨其在急性冠状动脉综合征(ACS)发病中的作用及其与冠状动脉病变程度的相关性及诊断意义。方法急性心肌梗死(AMI)组31例、不稳定型心绞痛(UAP)组32例、稳定型心绞痛(SAP)组35例,另选取同期30例正常健康者为对照组。酶联免疫吸附法(ELISA)测定血清IL-6、IL-18、MMP-2、MCP-1和CRP的浓度;速率散射法测血清CRP水平;血脂及脂蛋白含量测定分别用酶化学法与直接测定法检测。结果急性冠脉综合征患者(ACS)IL-6、IL-18和CRP水平,均显著高于对照组(P<0.05,P<0.01)和SAP组患者(P<0.05,P<0.01)。随着病情的加重,IL-6、IL-18、MMP-2和MCP-1水平均表现出进行性升高的趋势。患者血清IL-6、IL-18与CRP水平显著相关;患者血清IL-6与IL-18水平亦呈正相关。结论 ACS实际上是炎症、免疫、脂质代谢紊乱等多种因素综合作用的结果,所以对ACS的诊断,应综合炎症、脂类代谢等多种因素,进行评价各检测指标的诊断意义;IL-6、IL-18与CRP,可作为ACS发病和冠脉病变不稳定严重程度的预测因子。     

阿托伐他汀和辛伐他汀治疗原发性高脂血症的疗效和不良反应对比

目的 比较阿托伐他汀和辛伐他汀治疗原发性高脂血症的疗效和不良反应.方法 选取我院2015年2月~2016年12月期间收治的原发性高脂血症患者100例,随机分为两组,每组50例.对照组和观察组分别采用辛伐他汀和阿托伐他汀治疗.比较两组血脂水平[密度脂蛋白胆固醇(HDL-C)、总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)和三酰甘油(TG)]、临床疗效和不良反应.结果 对照组患者HDL-C明显低于观察组,TC、LDL-C、TG明显高于观察组,差异有统计学意义(P<0.05);对照组总有效率(82.00%)明显低于观察组(96.00%),差异有统计学意义(WTBXP<0.05);对照组不良反应发生率(16.00%)明显高于观察组(2.00%),差异有统计学意义(P<0.05).结论 阿托伐他汀治疗原发性高脂血症的疗效确切,能明显改善患者血脂水平,降低不良反应发生率,安全性高,具有较高的临床应用价值.     

覆膜支架治疗B型主动脉夹层25例的临床研究

目的探讨覆膜支架治疗B型主动脉夹层的有效性和安全性。方法 2006年1月至2009年3月我院收治B型主动脉夹层患者共25例,其中男20例,女5例,年龄56～78岁。入院后7～14天行覆膜支架治疗,观察术中、术后及出院后1年内并发症情况,分析其临床特点、疗效及随访结果。结果手术成功率100%,手术时间为90～150min,术中失血50～100ml;2例患者植入了2个覆膜支架,其余23例各植入1个。20例患者术后住院期间出现中高热,白细胞数增高,予短期应用激素等对症治疗后症状消失;1例腹股沟切口血肿,予探查切口彻底止血。术后平均住院时间11天,无死亡。随访时间为3～28个月,随访率为100%。13例术后6个月至12个月内行CT检查示,10例假腔内完全血栓形成,3例近端内漏患者假腔内部分血栓形成,降主动脉直径并无增大。结论覆膜支架治疗B型主动脉夹层具有创伤小、严重并发症少、住院时间较短的优势。     

心脏再同步化治疗窄QRS波群慢性心力衰竭患者的疗效观察

目的:观察心脏再同步化治疗(CRT)对窄QRS波群慢性心力衰竭(CHF)患者的临床疗效。方法:对7例窄QRS波群的CHF患者行CRT治疗,观察患者的NYHA心功能分级、左心室射血分数(LVEF)、左心室舒张末内径(LVIDd)、6 min步行试验(6 MWD)、左心室收缩期达峰时间的标准差(Ts-SD)和左室间隔和侧壁基底段收缩期达峰时间差(Ts)的变化情况。结果:CRT术程顺利,术后6月,患者临床症状明显改善,NYHA心功能分级[(3.6±0.5)vs.(2.7±0.6)]、LVEF[(0.26±0.04)vs(0.32±0.08)]和6 MWD[(203±9.3)m vs.(343±11.3)m]明显改善(P<0.05);LVIDd[(73.9±5.4)mm vs(68.1±3.2)mm]、Ts-SD[(47.3±6.5)ms vs(34.2±7.8)ms]和Ts[(92.1±27.2)ms vs(64.4±8.5)ms]较术前均显著缩小(P<0.05)。结论:对于经组织多普勒超声检查明确存在心室机械收缩不同步的窄QRS波群CHF患者,CRT治疗可一定程度改善其心功能及临床症状,其长期疗效和安全性评价有待大规模临床试验进一步评价。     

阿托伐他汀干预对急性冠状动脉综合征患者PCI术后粘附分子水平的影响

目的探讨不同剂量阿托伐他汀治疗对ACS（急性冠状动脉综合征）患者急诊经皮冠状动脉介入治疗（PCI）术后粘附分子水平的影响。方法入选88例ACS患者随机分为：A常规治疗组30人,B阿托伐他汀标准剂量组29人,C阿托伐他汀负荷剂量组29人。三组分别于术前、术后3、7、14天抽血,用ELISA法测定血清可溶性细胞间粘附分子（soluble intercellular adhesionmolecule-1,sICAM-1）、血管细胞粘附分子（soluble vascular cell adhesion molecule-1,sVCAM-1）水平。结果阿托伐他汀80mg,d组在治疗第7天,两种血清粘附分子水平显著低于阿托伐他汀10mg／d组,两组sICAM-1分别是（68．35±23．80）μg／L和（131．45±29．12）μg／L、sVCAM-1分别是（251．65±36．61）μg／L和（334．87±32．98）μg／L。此外,两组阿托伐他汀治疗剂量均显示可以显著减少两种粘附分子的水平（P〈0．05）,观察时段内各组对血脂水平影响无显著性差异（P〉0．05）结论阿托伐他汀治疗组比常规治疗组可以显著降低粘附分子水平,其中阿托伐他汀术后负荷剂量冲击治疗,较标准剂量更能显著降低血清粘附分子水平,从而抑制PCI术后的炎症反应的发生,减少术后再狭窄的发生。