非ST段抬高型急性冠状动脉综合征患者经皮冠状动脉介入术前强化他汀治疗对心血管事件的影响

目的 探讨非ST段抬高型急性冠状动脉综合征(NSTE-ACS)患者经皮冠状动脉介入(PCI)术前强化他汀治疗对心血管事件的影响.方法 100例NSTE-ACS患者完全随机分为2组,每组50例.常规他汀组PCI术前7 d给予辛伐他汀20 mg/d;强化他汀组PCI术前7 d给予阿托伐他汀40 ms/d.2组患者均接受其他常规治疗.比较2组在PCI前后心肌损伤标记物变化;观察随访1个月时患者主要心血管事件的发生率.结果 常规治疗组服药前、PCI术前及PCI术后肌酸激酶(CK-MB)分别为(18.94±24.35)、(13.57±6.42)、(15.39±10.08)μg/L;肌钙蛋白(TnI)分别为(0.82±3.09)、(0.46±1.38)、(0.82±2.52)μg/L;强化他汀组服药前、PCI术前及PCI术后CK-MB分别为(19.43±21.96)、(12.49±6.40)、(12.68±12.54)μg/L,Tnl分别为(3.18±9.53)、(0.61±2.51)、(0.72±0.47)μg/L.强化他汀组PCI术前较服药前下降,差异有统计学意义(P<0.05).NSIE-ACS患者PCI术前强化他汀治疗后CK-MB、ThI水平下降较常规他汀组更明显(P<0.05);PCI术后常规他汀组CK-MB、TnI水平的上升与强化他汀组差异有统计学意义(P<0.05).PCI术后随访1个月,常规他汀组心肌梗死1例(2.0%),靶血管再次血运重建2例(4.0%);强化他汀组无主要心血管事件发生.强化他汀组心血管事件发生率较常规他汀组低,但2组差异无统计学意义(P>0.05).结论 NSTE-ACS患者PCI术前强化他汀治疗较常规剂量他汀治疗能够减少术后心肌损伤.

Abstract：

Objective To observe the impact of aggressive statin treatment prior to percutaneous coronary intervention (PCI) in patients with non-ST segment elevation acute coronary syndrome (NSTE-ACS) on cardiovascular events.Methods One hundred NSTE-ACS patients were enroned and randomized into 2 groups:standard and aggressive statin treatment.The standard group received simvastatin 20 mg per day and the aggressive statin treatment group received atorvastatin 40 mg per day for 7 days prior to PCI,respectively.Both groups received other standard medical therapy.Biomarkers of cardiac injury were measured and compared before and after PCI.Major cardiovascular adverse events were evaluated during one month period of follow-up.Results Both CK-MB and TnI levels were significantly reduced after aggressive statin treatment compared to standard dose(P<0.05).After PCI,CKMB and TnI levels were significantly elevated in NSTE-ACS patients with standard dose than in patients with aggressive statin treatment(P<0.05).Major cardiovascular adverse events were reduced in aggressive statin treatment group,however,no statistical difference was observed between the two groups.Conclusion Aggressive statin treatment prior to PCI may be more effective in reducing post-PCI myocardial injury than normal dose of statin therapy in NSTE-ACS patients.     

脑利钠肽和N末端脑钠肽原在冠心病中的临床应用

脑利钠肽(BNP)是一种主要由心室肌细胞合成和分泌的多肽类心脏激素,它和相应的N端残基即N末端脑钠肽原(NT-proBNP)一起,当心室壁张力升高时分泌量增加。冠心病心肌缺血可导致心脏收缩和舒张功能障碍,使心室壁张力增加,BNP和NT-proBNP释放增多。目前已有越来越多的研究表明BNP和NT-proBNP同缺血性心脏病密切相关,其水平可以反映心肌缺血程度、评价左心室收缩与舒张功能不全、预后评估及治疗指导,具有一定的临床应用前景。作者通过查阅近年来国内外相关文献并加以分析、整理和总结,就BNP和NT-proBNP的基本理论及其在冠心病领域的临床应用作一综述。     

针刺治愈阿托品过量所致暂时性双目失明一例

我们于1977年7月曾遇一例阿托品用药过量所致暂时性双目失明病例: 马×,女,8个月。因婴儿腹泻打针服药不止,其母自用大烟壳小半个水煎灌服1小汤匙,服后当即有恶心、呕吐,腹泻未能控制。当夜在某医院诊治,给予土霉素0.05克,并肌注阿托品半支(0.5毫升内含阿托品0.5毫克)约半小时后,患婴颜面潮热,皮肤干燥红润,烦躁不安,心率加快,考虑是阿托品用药后反应,未作特殊处理。次晨,患婴骤然出现视力模糊,双眼不能视物,吃奶时看不见奶     

生脉注射液对冠心病患者血液粘度,血小板粘附、聚集和左心室功能的影响

用生脉注射液对53例冠心病住院患者进行治疗,观察治疗前后血粘度、血小板粘附、血小板聚集和左心室功能的变化。结果显示:生脉注射液可明显降低血液粘度(P<<0.01),明显降低血小板粘附、血小板1分、5分及血小板最大聚集作用(P<0.01),明显改善左心室功能(P<0.01),同时降低外周血管阻力(P<0.01)。生脉注射液有利于疏通小血管内的血液淤滞,提高心肌耐缺氧能力,从而增加心脏泵血功能。