天津医药

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强化他汀治疗对急诊PCI术后早期心率变异性及恶性室性心律失常的影响

王雪梅   

  1. 天津市宁河县医院
  • 收稿日期:2013-07-23 修回日期:2013-09-04 出版日期:2014-04-15 发布日期:2014-04-15
  • 通讯作者: 王雪梅

The Influence of High-Dose Atorvastatin in Heart Rate Variability and Malignant Ventricular Arrhythmia in Patients Underwent Emergency PCI

  • Received:2013-07-23 Revised:2013-09-04 Published:2014-04-15 Online:2014-04-15

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摘要：

【摘要】目的 探讨大剂量阿托伐他汀（80mg/d）对急诊冠状动脉介入（PCI）术后早期心率变异性(HRV)及恶性室性心律失常（MVA）的影响。方法 将350例行急诊PCI治疗的急性心肌梗死（AMI）患者随机均分为大剂量他汀组（大剂量组）和常规剂量他汀组（常规剂量组），另设对照组85例。大剂量组入院立即口服阿托伐他汀80mg/d，第2天起改为40mg/d，常规剂量组入院立即口服阿托伐他汀40mg/d，第2天起改为20mg/d。术后24h连续行动态心电图（Holter）检测，并根据Holter结果比较各组HRV及MVA发生率。结果 大剂量组和常规剂量组SDNN（ms：108.3± 21.5、70.6±17.6）、SDANN（ms：111.7±19.2、65.9±18.5）、RMSSD（ms：25.6±8.3、18.7±10.2）和PNN50 （%：14.7±5.9、6.9±3.4）均低于正常对照组（分别为122.5±23.8、119.6±15.2、29.2±9.3及17.7±6.5），大剂量组高于常规剂量组（均P＜0.05）。大剂量组和常规剂量组MVA发生率均高于正常对照组（12.00%vs21.14%vs2.35%），大剂量组低于常规剂量组（χ 2 = 5.29，P＜0.05）。结论 AMI患者梗死早期HRV减低，MVA发生率增加；大剂量阿托伐他汀能够增加急诊PCI术后早期HRV，并降低MVA发生率。

关键词: 他汀, 心肌梗死, PCI, 心率变异性, 室性心律失常

Abstract: Objective To study the influence of high dose atorvastatin (80 mg) on early heart rate variability and malignant ventricular arrhythmia in patients underwent emergency PCI. Methods 350 cases underwent emergency PCI from January 2010 to January 2013 were randomly divided into two groups: high dose atorvastatin group (175 cases) and regular dose atorvastatin group (175 cases); and 85 cases of control were enrolled randomly(control group). The patients of high dose atorvastatin group received atorvastatin 80 mg orally instantly after hospitalization and 40 mg once a day from the second day; The patients of regular dose atorvastatin group received atorvastatin 40mg orally instantly after hospitalization and 20 mg once a day from the second day. The patients received continuous dynamic electrocardiogram detection for 24 hours after PCI and according to the dynamic electrocardiogram outcomes , the early heart rate variability and malignant ventricular arrhythmia were measured and compared between groups. Results (1) Compared with the normal control group, the heart rate variability was significantly reduced, the incidence rate of malignant ventricular arrhythmia was much higher in patients with acute myocardial infarction(P<0.01). (2) Compared with the regular dose atorvastatin group, the heart rate variability was significantly increased(P<0.05), the incidence rate of malignant ventricular arrhythmia was much lower in high dose atorvastatin group after emergency PCI (P=0.03). Conclusion The heart rate variability was significantly reduced and the incidence rate of malignant ventricular arrhythmia was much higher in patients with early acute myocardial infarction; high dose atorvastatin can increase the heart rate variability and decrease the incidence rate of malignant ventricular arrhythmia in patients underwent emergency PCI.

Key words: Statins, myocardial infarction, PCI, heart rate variability, malignant ventricular arrhythmia