郑修广 张作文

[摘要] 目的 探討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。

[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

[中图分类号] R453 [文献标识码] A [文章编号] 1673-7210（2018）10（b）-0062-04

[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

调查显示[1]，每年我国约有230万老年患者出现各种原因的骨折。由于老年患者机体各项机能较差，在围术期容易出现各种并发症及合并症；缺血性脑卒中是老年患者常见的一种疾病，其具有较高的致残率和致死率。颈动脉粥样斑块是导致缺血性脑卒中的重要原因之一，氧化应激学说被认为是引起颈动脉粥样斑块发生发展的重要机制[2]。多项研究表明[3-4]，阿托伐他汀对于血脂异常患者不仅具有调脂作用，还能够降低机体氧化应激水平，发挥抗炎、抗粥样硬化、改善内皮功能及稳定斑块的作用。……