不同剂量阿托伐他汀在合并颈动脉不稳定斑块的高龄骨折患者围术期缺血性脑卒中中的治疗效果

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摘要目的探讨不同剂量阿托伐他汀在治疗合并颈动脉不稳定斑块的高龄骨折患者围术期缺血性脑卒中中的临床效果及对应激指标、颈动脉斑块稳定性的影响。方法选取重庆市江津区中心医院2015年1月～2017年4月收治的围术期出现脑卒中的老年骨折患者76例，按照随机数字表法分为观察组和对照组，每组各38例，对照组予阿托伐他汀10 mg/d口服，观察组予阿托伐他汀20 mg/d口服，连续治疗6个月，观察两组患者临床疗效、应激反应指标水平及颈动脉斑块稳定性。结果治疗后观察组临床总有效率高于对照组，差异有统计学意义（P ＜ 0.05）；治疗4周后观察组丙二醛、氧化低密度脂蛋白水平明显低于对照组，差异有统计学意义（P ＜ 0.05）；治疗6个月后观察组美国国立卫生研究院卒中量表（NIHSS）评分、动脉斑块面积、颈动脉内膜厚度（Crouse）评分明显低于对照组，差异有统计学意义（P ＜ 0.05）；两组患者不良反应比较差异无统计学意义（P ＞ 0.05）。结论较大剂量的阿托伐他汀治疗合并颈动脉不稳定斑块的高龄骨折患者围术期缺血性脑卒中的效果满意，能够有效减轻患者氧化应激损伤，减少斑块面积，安全可靠。

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关键词 ：阿托伐他汀, 高龄骨折, 颈动脉斑块, 缺血性卒中, 氧化应激

Abstract：Objective To investigate the effects of different dose of Atorvastatin on elderly patients with unstable carotid plaques complicated ischemic stroke in perioperative period, and the effects on stress and carotid plaque stability. Methods Seventy-six elderly patients with fractures admitted to Jiangjin District Central Hospital in Chongqing City from January 2015 to April 2017 were selected and they were divided into observation group and control group according to the random number table method, with 38 cases in each group. The control group was given Atorvastatin 10 mg/d oral and the observation group was given Atorvastatin 20 mg/d oral. The treating course was 6 months. The clinical efficacy, stress response index and carotid plaque stability were observed in the two groups. Results After treatment, the total clinical effective rate of the observation group was higher than that of the control group, and the difference was statistically significant (P ＜ 0.05). After 4 weeks of treatment, the levels of malondialdehyde and low density lipoprotein in the observation group was significantly lower than those of the control group, the difference was statistically significant (P ＜ 0.05). After 6 months of treatment, scores of the scale of the National Institutes of Health of the United States (NIHSS), arterial plaque area and carotid artery intima thickness (Crouse) scores were significantly lower in the observation group than those in the control group, the difference was statistically significant (P ＜ 0.05). There was no significant difference in the adverse reaction between the two groups (P ＞ 0.05). Conclusion Large dose of Atorvastatin in the treatment of elderly fracture patients with unstable carotid artery atherosclerotic plaques complicated ischemic stroke in perioperative period has a satisfatory curative effect, which can effectively reduce the injury of oxidative stress, reduce the area of plaque, and it is safe and reliable.

Key words： Atorvastatin Advanced fracture Carotid plaque Ischemic stroke Oxidative stress

基金资助:重庆市卫计委医学科研计划项目（2017ZBXM029）。

通讯作者: ▲通讯作者

作者简介: 郑修广（1963-），男，副主任医师，主要从事神经内科疾病（脑血管病、帕金森病、失眠等）研究。

引用本文:

郑修广张作文▲. 不同剂量阿托伐他汀在合并颈动脉不稳定斑块的高龄骨折患者围术期缺血性脑卒中中的治疗效果[J]. 中国医药导报, 2018, 15(29): 62-65.
ZHENG Xiuguang ZHANG Zuowen▲ . Clinical effect of different dose of Atorvastatin on elderly patients with unstable carotid plaques complicated ischemic stroke in perioperative period. 中国医药导报, 2018, 15(29): 62-65.

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http://www.yiyaodaobao.com.cn/CN/ 或 http://www.yiyaodaobao.com.cn/CN/Y2018/V15/I29/62

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