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目的探讨大剂量阿托伐他汀对急性ST段抬高心肌梗死(STEMI)溶栓后左室收缩功能及血浆脑钠肽(BNP)水平影响。方法 80例接受急诊溶栓的急性ST段抬高心肌梗死(STEMI)患者分为他汀大剂量组(40例)和他汀常规剂量组(40例),他汀大剂量组在艾通立(rt-PA,50mg)溶栓前给予阿托伐他汀80mg顿服,溶栓后继续给予40mg/d,他汀常规剂量组溶栓前不使用他汀类药物,溶栓后给予20mg/d。二组患者均接受其他常规治疗。溶栓后24h内及1个月后应用电化学发光法测定检测血清脑钠肽(BNP)的水平。应用超声心动图检测二组患者的左室舒张末内径(LVEDd)、左室射血分数(LVEF)及左室短轴缩短率(LVFS)。结果 STEMI患者1个月后他汀大剂量组LVEDd显著低于他汀常规剂量组,LVEF和LVFS显著高于常规剂量组;STEMI患者在应用阿托伐他汀40mg和20mg治疗1个月时,血浆BNP与治疗前比较差异有统计学意义(P<0.01),且二组比较差异亦有统计学意义(P<0.05)。结论急诊行溶栓治疗的急性心肌梗死患者使用阿托伐他汀序贯治疗对心肌具有更强的保护作用,能够抑制AMI后的心室重塑,改善患者左心室功能,减少心衰发生,从而改善患者长期愈后,降低病死率。
Objective To investigate the effect of high-dose atorvastatin on left ventricular systolic function and plasma brain natriuretic peptide (BNP) level after thrombolysis with acute ST-segment elevation myocardial infarction (STEMI). Methods Eighty patients with acute ST-segment elevation myocardial infarction (STEMI) undergoing thrombolytic therapy were divided into high dose statin group (n = 40) and statin group (n = 40) PA, 50mg) given atorvastatin 80mg Dayton clothing before thrombolysis, continue to give after thrombolysis 40mg / d, statins in the conventional dose group before thrombolysis without statins, given after thrombolysis 20mg / d. Two groups of patients received other routine treatment. The level of serum brain natriuretic peptide (BNP) was determined by electrochemiluminescence method within 24 hours and 1 month after thrombolysis. Left ventricular end-diastolic diameter (LVEDd), left ventricular ejection fraction (LVEF) and left ventricular fractional shortening (LVFS) were measured by echocardiography. Results After 1 month of STEMI, the LVEDd of high-dose statin group was significantly lower than that of statin-normal dose group, LVEF and LVFS were significantly higher than those of conventional dose group. In STEMI patients treated with atorvastatin 40mg and 20mg for 1 month, plasma BNP and The differences between the two groups before treatment were statistically significant (P <0.01), and the difference between the two groups was also statistically significant (P <0.05). Conclusions Emergency treatment of acute myocardial infarction in patients with acute myocardial infarction using atorvastatin sequential therapy has a stronger protective effect on the myocardium, can inhibit ventricular remodeling after AMI, improve patients with left ventricular function, reduce heart failure, thereby improving The longer the patient, reduce mortality.