中国组织工程研究

中国组织工程研究 ›› 2010, Vol. 14 ›› Issue (4): 736-739.doi: 10.3969/j.issn.1673-8225.2010.04.039

• 骨与关节临床实践 clinical practice of the bone and joint • 上一篇    下一篇

大脑中动脉支架置入后阿托伐他汀对缺血性不良事件的影响：24例12个月随访

李文澜1，柯  伟2，邓小容2   

  1. 1 武汉大学人民医院麻醉科， 湖北省武汉市 430060；2 湖北省中山医院神经内科，湖北省武汉市  430033
  • 出版日期:2010-01-22 发布日期:2010-01-22
  • 作者简介:李文澜★，女，1981年生，湖北省麻城市人，2005年武汉大学毕业，硕士，医师，主要从事围手术期脏器保护研究。 liwenlan0393@126.com

Influence of atorvastatin on ischemic adverse events following cerebral middle artery stent implantation: A 12-month follow-up in 24 cases

Li Wen-lan1, Ke Wei2, Deng Xiao-rong2   

  1. 1 Department of Anesthesiology, Renmin Hospital of Wuhan University, Wuhan  430060, Hubei Province, China; 2 Department of Neurology, Zhonshan Hospital, Wuhan  430033, Hubei Province, China
  • Online:2010-01-22 Published:2010-01-22
  • About author:Li Wen-lan★, Master, Physician, Department of Anesthesiology, Renmin Hospital of Wuhan University, Wuhan 430060, Hubei Province, China liwenlan0393@126.com

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摘要：

背景：血管内支架置入已成为治疗颅内外动脉狭窄的主要方法之一，目前支架置入的安全性和有效性已明显提高，能够明确改善血管狭窄有关的症状及预后，并预防缺血性事件的发生，但仍存在如血栓形成、脑出血、再狭窄以及过度灌注等问题。
目的：探讨阿托伐他汀对大脑中动脉支架置入后缺血性不良事件的影响。
方法：将24例成功完成大脑中动脉支架置入患者随机分为2组，治疗组口服阿托伐他汀40 mg+硫酸氢氯吡格雷75 mg+拜阿司匹林300 mg,1次/d，对照组口服硫酸氢氯吡格雷75 mg+拜阿司匹林300 mg，1次/d，术后1，3，6，12个月以经颅多普勒、数字减影血管造影、核磁共振成像/扩散成像、C-反应蛋白、血脂以及神经专科随访，观察主要的不良事件如支架内再狭窄、短暂性脑缺血发作、脑梗死、再次介入治疗的发生情况。
结果与结论：与对照组比较，治疗组术后1，3，6，12个月血脂及C-反应蛋白水平明显下降(P < 0.05，P < 0.01)，缺血性不良事件的发生率明显降低(P < 0.05，P < 0.01)。治疗组术后血脂及C-反应蛋白水平较术前明显降低(P < 0.05，P < 0.01)。同时接受阿托伐他汀治疗的患者均未出现严重的不良反应，说明40 mg是安全的。结果提示可以将他汀类降脂药作为支架置入后的常规治疗，联合抗血小板治疗可以很好的预防支架置入后缺血性不良事件的发生。

关键词: 阿托伐他汀, 支架, 缺血性不良事件, 大脑中动脉, 脑血管植入物

Abstract:

BACKGROUND: Intravascular stent implantation is one of the main methods for intra-extracranial artery stenosis. The safety and efficacy of stent implantation has been elevated, and symptoms or ischemic advert events with artery stenosis has been reduced. However, risks of thrombosis, cerebralhemorrhage, restenosis, and hyperperfusion still existed.
OBJECTIVE: To investigate the influence of atorvastatin on ischemic adverse events following cerebral middle artery stent implantation.
METHODS: Twenty-four patients received cerebral middle artery stent implantation were randomly divided into 2 groups. In the treatment group, patients were received atorvastatin 40 mg + plavix 75 mg + aspirin enteric-coated tablet 300 mg, once per day; in the control group, patients were received plavix 75 mg + aspirin enteric-coated tablet 300 mg, once per day. Ischemic adverse events, such as in-stent restenosis, transient ischemic attack, cerebral infarction, or re-interventional therapy were observed by transcranial Doppler, digital subtraction angiography, nuclear magnetic resonance imaging, diffusion weighted imaging, blood lipid level and C-reactive protein level examinations prior to and at months 1, 3, 6 and 12 after stent implantation.
RESULTS AND CONCLUSION: Compared with the control group, the levels of blood lipid and C-reactive protein were obviously decreased at months 1, 3, 6 and 12 after treatment (P < 0.05, P < 0.01), with dramatically declined ischemic adverse events (P < 0.05, P < 0.01). Compared with before operation, the levels of blood lipid and C-reactive protein were decreased after operation in the treatment group (P < 0.05, P < 0.01). No server adverse events occurred in patients treated by atorvastatin, which showed 40 mg was safe for patients. The results revealed that atorvastatin combined with antiplatelet therapy can prevent ischemic adverse events following cerebral middle artery stent implantation.

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