摘要
目的观察高负荷量瑞舒伐他汀配合复方丹参滴丸对ST段抬高型心肌梗死(STEMI)经皮冠状动脉介入治疗(PCI)后心电图ST段回落不良患者血管内皮功能及预后的影响。方法将90例STEMI经PCI后心电图ST段回落不良患者随机为观察组和对照组,每组45例。2组均接受常规治疗,对照组在常规治疗基础上给予瑞舒伐他汀20 mg/d口服,观察组在对照组基础上给予复方丹参滴丸(10丸/次,3次/d)口服,2组均治疗2周。记录2组的临床疗效,并比较2组治疗前后心肌酶谱[血浆肌钙蛋白I(cTnI)、肌酸激酶同工酶(CK-MB)、肌酸激酶(CK)、乳酸脱氢酶(LDH)、天门冬氨酸氨基转移酶(AST)]、心功能指标[左室射血分数(LVEF)、缩短分数(FS)、左室舒张末期内径(LVEDD)、E/A和血浆N端脑钠肽前体(NT-proBNP)]、血管内皮功能指标[肱血流介导的血管扩张功能(FMD)、非内皮依赖性舒张功能(NMD)及血浆内皮素(ET-1)、一氧化氮(NO)、一氧化氮合酶(NOS)]的变化及2组PCI后30 d的主要心脏不良事件(MACE)发生率。结果观察组临床总有效率显著高于对照组(P<0.05);2组治疗后血浆心肌酶谱各指标水平均显著降低(P均<0.05),且观察组治疗后以上指标水平均显著低于对照组(P均<0.05);2组治疗后LVEF、FS、E/A、FMD、NMD及血浆NO、NOS水平均较治疗前显著升高(P均<0.05),LVEDD及血浆NT-proBNP、ET-1水平均较治疗前显著降低(P均<0.05),观察组治疗后以上指标改善情况均显著优于对照组(P均<0.05)。2组PCI后均随访30 d,观察组MACE发生率显著低于对照组(P<0.05)。结论高负荷量瑞舒伐他汀配合复方丹参滴丸可有效促进STEMI患者PCI后的心电图ST段回落,减轻心肌缺血损害程度和改善心功能,降低MACE发生率,其机制可能与改善血管内皮功能,从而改善心肌微循环状态有关。
Objective It is to observe the effect of high-load rosuvastatin combined with Compound Danshen Dropping Pills on vascular endothelial function and prognosis in patients with ST-segment elevation myocardial infarction(STEMI)with poor ST-segment regression after percutaneous coronary intervention(PCI).Methods Ninety patients with poor ST segment regression of ECG after PCI were randomly divided into observation group and control group,45 cases in each group.Both groups received routine treatment.The control group was given rosuvastatin 20 mg/d orally on the basis of routine treatment.The observation group was given Compound Danshen Dropping Pills(10 pills/time,3 times/day)orally on the basis of the control group.Both groups were treated for 2 weeks.The clinical efficacy of the two groups was recorded,and the changes of myocardial enzymes[plasma troponin I(cTnI),creatine kinase isozymes(CK-MB),creatine kinase(CK),lactate dehydrogenase(LDH),aspartate aminotransferase(AST)],cardiac function indexes[left ventricular ejection fraction(LVEF),shortened fraction(FS),left ventricular end-diastolic diameter(LVEDD,E/A and plasma N-terminal brain natriuretic peptide precursor(NT-proBNP)],vascular endothelial function indicators[brachial flow-mediated vasodilation function(FMD),non-endothelial dependent relaxation function(NMD),plasma endothelin-1(ET-1),nitric oxide(NO),nitric oxide synthase(NOS)]before and after treatment and the incidence of major adverse cardiac events(MACE)30 days after PCI were observed in the two groups.Results The total clinical effective rate of the observation group was significantly higher than that of the control group(P<0.05);the levels of plasma myocardial enzymes in the two groups were significantly decreased after treatment(P<0.05),and the above indexes in the observation group were significantly lower than those in the control group(P<0.05).The levels of LVEF,FS,E/A,FMD,NMD,plasma NO and NOS in the two groups were significantly increased,while the levels of LVEDD,NT-proBNP and ET-1 in plasma were significantly decreased after treatment(P<0.05),the improvement of the above indexes in the observation group was significantly better than that in the control group(P<0.05).Both groups were followed up for 30 days after PCI,the incidence of MACE in the observation group was significantly lower than that in the control group(P<0.05).Conclusion High-load rosuvastatin combined with Compound Danshen Dropping Pills can effectively promote ST segment depression of ECG after PCI,alleviate myocardial ischemia damage and improve cardiac function,and reduce the incidence of MACE in STEMI patients.The mechanism may be related to improvement of myocardial microcirculation due to the improvement of vascular endothelial function.
作者
李蒙
胡宏宇
穆利英
韩丽军
LI Meng;HU Hongyu;MU Liying;HAN Lijun(Beijing Tiantan Hospital Affiliated to Capital Medical University,Beijing 100070,China)
出处
《现代中西医结合杂志》
CAS
2019年第26期2893-2898,共6页
Modern Journal of Integrated Traditional Chinese and Western Medicine
关键词
瑞舒伐他汀
复方丹参滴丸
ST段抬高型心肌梗死
经皮冠状动脉介入治疗
ST段回落不良
血管内皮功能
主要心脏不良事件
rosuvastatin
Compound Danshen Dropping Pill
ST-segment elevation myocardial infarction
percutaneous coronary intervention
poor ST-segment regression
vascular endothelial function
major adverse cardiac event
