高龄急性心肌梗死患者PCI围术期服用高剂量阿托伐他汀的疗效及安全性研究

目的：探讨高龄急性心肌梗死患者急诊经皮冠状动脉介入治疗（Percutaneous coronary intervention，PCI）围术期服用高剂量阿托伐他汀的疗效及安全性。方法：将急诊PCI手术治疗的高龄急性心肌梗死患者120例，随机分为实验组和对照组，每组60例，除接受常规药物治疗外，实验组：术前半小时口服负荷量阿托伐他汀80mg，术后d1开始口服40mg，每晚1次，持续3个月；对照组：术前半小时口服阿托伐他汀20mg，术后d1开始口服20m，每晚1次，持续3个月。比较两组术前半小时血清中肌钙蛋白（cTnI）、超敏C反应蛋白（hs-CRP）、胱抑素C、肌酐水平及术后24h cTnI、hs-CRP和术后48h胱抑素C、肌酐的水平；并比较术后3个月两组的LDL、肌酐、胱抑素C、肝功能，和主要不良事件（心源性死亡、急性心肌梗死、心力衰竭、心绞痛发作、肝损害及股骨肌溶解等）的发生情况。结果：实验组PCI术后24h cTnI、hs-CRP水平及术后48h胱抑素C、血清肌酐的水平均较对照组显著降低（P<0．05），实验组术后3月LDL较对照组显著下降（P<0．05），急性心肌梗死、心绞痛发生率显著低于对照组（P<0．05）。结论：高龄急性心肌梗死患者PCI围术期高剂量阿托伐他汀治疗疗效好且安全，值得临床推广。

Efficiency and safety of high dose atorvastatin treatment to old acute myocardial infarction patients before and after PCI

Objective: To study the efficiency and safety of high dose atorvastatin to old acute myocardial infarction patients before and after Percutaneous coronary intervention(PCI).Methods:A total of 120 old patients of acute myocardial infarction randomly were divided into experimental group and control group ,with 60 cases in each group.Except routine medicine therapy ,The experimental group taked atorvastatin 80mg 30 minutes before PCI, and 40mg after PCI everyday for three months, while the control group a dose of 20mg.We compared cTnI, hs-CRP, Cystatin–C and creatinine 30 minutes before PCI, cTnI and hs-CRP 24 hours after PCI and Cystatin–C and creatinine 48 hours after PCI of each group.3 months after PCI,We compared LDL, creatinine and Cystatin–C ,Of cause two groups of patients were followed up major adverse events (cardiac death, acute myocardial infarction, heart failure, angina pectoris, etc.) .Results:cTnI, CRP, cystatin C, serum creatinine of the experimental group after PCI were significantly lower than the control group(P<0.05). LDL of the experimental group was decreased significantly than that of the control group 3 months later(P<0.05), the same to the incidence of cardiovascular events such as acute myocardial infarction and angina pectoris. Conclusions: High dose atorvastatin treatment to old acute myocardial infarction patients before and after PCI is both effective and safe, Worthy of promotion.