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目的:探讨大剂量阿托伐他汀(80mg)在预防老年(年龄≥60岁)急诊经皮冠状动脉内介入治疗术(急诊PCI)后造影剂相关肾病(CIN)的作用。方法:将2009-09-2011-03住院行急诊PCI术治疗的老年急性心肌梗死患者85例随机分为大剂量阿托伐他汀组和常规剂量阿托伐他汀组。2组患者在水化治疗的基础上,大剂量阿托伐他汀组在入院后即刻口服阿托伐他汀80mg,急诊PCI术后3d内每日口服阿托伐他汀40mg;常规剂量阿托伐他汀组入院后即刻及急诊PCI术后3d内每日口服阿托伐他汀20mg。然后分别测定并比较2组患者造影后24、72h的血清尿素氮(BUN)、血清肌酐(Scr)、内生肌酐清除率(Ccr)以及造影剂肾病(CIN)的发生率。结果:急诊PCI术后72h大剂量阿托伐他汀组BUN及Scr增加值和增加百分比明显低于常规剂量阿托伐他汀组(P<0.05),Ccr下降值和下降比率以及CIN的发生率(13.95%∶33.33%)亦明显低于常规剂量阿托伐他汀组(P<0.05)。结论:应用大剂量阿托伐他汀可能对老年患者急诊PCI术后CIN的发生具有一定的预防保护作用。
Objective: To investigate the effect of high dose atorvastatin (80 mg) on the prevention of contrast-related nephropathy (CIN) after percutaneous coronary intervention (emergency PCI) in the elderly (≥60 years old). Methods: Eighty-five elderly patients with acute myocardial infarction who underwent emergency PCI during 2009-09-2011-03 were randomly divided into high-dose atorvastatin group and conventional-dose atorvastatin group. On the basis of hydration therapy, two groups of patients were given oral atorvastatin 80 mg immediately after admission and atorvastatin 40 mg daily for 3 days after emergency PCI. Atorvastatin Group immediately after admission and emergency PCI within three days after oral administration of atorvastatin 20mg. Then the levels of serum BUN, SCr, Ccr and CIN were measured and compared 24 hours and 72 hours after angiography in two groups. Results: The increment and percentage increase of BUN and Scr in high-dose atorvastatin group 72h after emergency PCI were significantly lower than those of conventional atorvastatin group (P <0.05), Ccr decrease and decrease rate, and the incidence of CIN 13.95%: 33.33%) was also significantly lower than the conventional dose of atorvastatin group (P <0.05). Conclusion: The use of high-dose atorvastatin may prevent and treat CIN in elderly patients after emergency PCI.