急性冠脉综合征他汀序贯治疗讲解课件.pptVIP

* As far as mechanisms are concerned, we can discuss these until we are blue in the face, said Di Sciascio, adding that he believes the mechanism to be independent of LDL lowering. Regardless of how the drugs work, Di Sciascio said, the data, if confirmed in other, larger studies, has the potential to change clinical practice. Specifically, statins might even be administered on first medical contact, not unlike aspirin or clopidogrel. I believe in moving very upstream with statin therapy, he said. Commenting on the results of the study during the late-breaking clinical-trials session, Dr Robert Harrington (Duke Clinical Research Institute, Durham, NC) said the trial is small but important, as it addresses the clinical problem that when clinicians intervene in the coronary artery, they unleash an inflammatory cascade that has the potential to turn into downstream events. However, confirmation of the benefits in larger trials is needed before clinicians start initiating the statin boost prior to PCI. Harrington noted, however, there is a relationship between long-term mortality and myocardial necrosis. * * 他汀治疗有效抗炎、抗氧化、改善内皮功能，也可以一定程度地抑制血小板聚集。 * 研究也证实阿托伐他汀强化治疗，早期获益显著 * 临床实践中，立普妥严重不良事件更少见。根据2003年10月1日－2004年9月30日间美国FDA收到的临床常用他汀的不良事件报告，可以看出，在临床实践中，立普妥的严重不良事件更少见。 * 综合以上ACS患者他汀治疗早、严、长的原则，以及中国患者的实际情况，提出ACS患者他汀续贯治疗新方案，对于急诊或择期PCI的患者建议 * 对于打算药物治疗的患者建议 选择性冠脉造影 选择性冠脉造影 PCI PCI 术后用药 立普妥 40mg Qd 拜阿司匹灵 100mg Qd 氯吡格雷 75mg Qd 依那普利 5mg Bid 倍他乐克 12.5mg Bid 曲美他嗪 20mg Tid 立普妥 40mg Qd用够3个月后减为20mg Qd。 PCI术后3个月复查 血脂：TC 4.65 mmol/L， TG 0.68 mmol/L， HDLc 1.42 mmol/L，LDLc 2.68 mmol/L 肝酶：ALT 21 U/L，AST 28 U/L 肌酸肌酶： 71 U/L 结果：肝酶无明显改变，无腓肠肌疼痛等，调脂基本达标。 病例分享2 女性，63岁，因胸痛3小时由外院转入。 有高血压史。 查体：BP126/70mmHg，两肺（-），心界不大，HR72次/分，律齐，心音低钝，无杂音。 ECG 治疗经过 入院后立即予“拜阿司匹灵”300mg嚼服，“氯吡格雷”300mg、“立普妥”80mg口服，并急诊送心导管室行选择性冠脉造影术及PCI术。 CAG CAG PCI PCI PCI PCI术后服药 立普妥 40mg Qd 拜阿司匹灵 100mg Qd 氯吡格雷 75mg Qd 依那普利 5mg Qd 立普妥 40mg Qd用够1个月后减为20mg Qd。 ARMYDA--