早期他汀类药物治疗对急性心肌梗死患者益处.docVIP

早期他汀类药物治疗对急性心肌梗死患者益处 　【摘要】 目的：探讨早期他汀类药物治疗对急性心肌梗死患者带来的益处。方法：571例急性心肌梗死患者分为他汀类药物治疗组和非他汀类药物治疗组，观察两组患者CK和CKMB的峰值变化、发生充血性心力衰竭的风险和院内死亡率的变化情况。结果：他汀类药物治疗组院内死亡率、CK和CKMB的峰值降低，进展为CHF的风险降低。结论：对急性心肌梗死患者在一般治疗的基础上早期应用他汀类药物治疗可获得很大的益处，且安全、可靠。 【关键词】 他汀类药物；急性心肌梗死；低充血性心力衰竭 　　Benefits of Very Early Administration of Statins during the First Day of Hospitalization in Patients with Acute Myocardial Infarction-A　　 　　Abstract：Objective To investigate the benefits of very early statin therapy in patients with acute myocardial infarction．Methods We identified 571 consecutive patients with AMI from 1998 to 2006 divided them into early statin therapy (statins were administered within the initial 24 h of hospitalization ，n=165) and nonstatin therapy groups (n=406)．We compared mortality risks，rates of CHF development and measures of peak CK and CKMB values between the groups．Results Inhospital mortality was lower in the early statin therapy group (2.9%) compared to the nonstatin therapy group (10.3%) ，P＜0.01．Patients with very early statin treatment had lower peak CK (605ng/ml) and CKMB (41 ng/ml) values compared to nonstatin patients (875 ng/ml and 92 ng/ml)，P＜0.01.Patients in the early statin group had lower risks of developing CHF during hospitalization (9.7%)compared to the nonstatin group (27.2%) ，P＜0.01.Conclousion Based on the traditional therapy,AMI can obtain many benefits from very early administration of statin therapy during the first day of hospitalization．It is an effective and safe method. 　　 　　Key words：Statins；Acute myocardial infarction;CHF 　　急性心肌梗死（AMI）发病初期死亡率较高，治疗的关键是尽早给予冠脉血运重建治疗，使闭塞的冠脉再通，恢复冠脉血流和心肌的再灌注。近年来，积极开展了溶栓、介入合并转换酶抑制剂、β受体阻滞剂、低分子肝素、氯吡格雷等治疗挽救了许多患者的生命，他汀类药物的治疗也越来越多地引起了人们的重视，关于早期应用他汀类药物能否降低充血性心力衰竭（CHF）风险和改变死亡时间，目前鲜有相关报道。为此，我们做了如下研究。 　　1 材料与方法 　　1.1 研究对象 　　1.1.1 入选标准 1998年至2006年我院心内科571例连续的急性心肌梗死（AMI）患者，均符合WHO关于急性心肌梗死的诊断标准。 　　1.1.2 排除标准 所有其他炎症性疾病和肝、肾功能不全，入院24 h内死亡者。如果随访期间发生其他炎症性疾病和严重肝、肾功能不全的病例也需剔除。 　　1.1.3 停药警戒值 血清总胆固醇(TC)lt;2.6 mmol/L；服药期间，若出现肌痛并肌酸激酶(CK)≥正常高限5倍