摘要
目的探析急性心肌梗死患者急诊经皮冠状动脉介入术(PCI)术前高负荷阿托伐他汀对术中无复流的预防及对心功能的保护作用。方法前瞻性选取2013年1月至2015年1月心内科收治的120例行急诊PCI术治疗的急性心肌梗死患者,采用投掷硬币法将其分为2组,每组各60例。对照组术前给予常规治疗,研究组术前在常规治疗基础上加用80 mg阿托伐他汀顿服。对比两组患者术中TIMI血流分级、TIMI心肌灌注分级(TMPG)情况以及手术前后N末端B型利钠肽前体(NT-pro BNP)和心脏超声各项指标水平变化情况。结果两组手术成功率均为100.00%。研究组无复流发生率明显低于对照组(15.00%vs 31.67%,P<0.05),TIMI血流分级Ⅲ级所占比例明显高于对照组(85.00%vs 68.33%,P<0.05),TMPG3级的比例明显高于对照组(73.33%vs 46.67%,P<0.05)。两组患者PCI术后1 d NT-pro BNP水平均较术前明显升高(P均<0.01),随后NT-pro BNP水平逐渐下降,研究组术后各时点下降程度均较对照组更明显(P均<0.05)。两组患者术后随时间推移左室射血分数(LVEF)水平递升,左室舒张末容积指数(LVEDVI)、左室收缩末容积指数(LVESVI)、室壁运动积分指数(WMSI)水平递降,至12月时与术后1周比较差异均有统计学意义(P均<0.05);且研究组各时点LVEF较对照组有所提高,LVEDVI、LVESVI、WMSI水平不同程度地低于对照组,至12月时差异均有统计学意义(P均<0.05)。结论急性心肌梗死直接PCI术前高负荷他汀类药物可有效改善缺血心肌的再灌注,预防术中无复流,改善心功能。
Objective To study the effects of high load atorvastatin use before emergency percutaneous coronary intervention（PCI）on preventing intraoperative no-reflow and protecting cardiac function in patients with acute myocardial infarction（AMI）.Methods A total of 120 AMI patients who underwent emergency PCI between January 2013 and January2015 were selected prospectively.The patients were divided into two groups（n = 60 each）：research group and control group by tossing coin method.The conventional therapy was given before procedure in control group,and 80 mg atorvastatin was administrated orally one-time before procedure on the basis of routine treatment in research group.The thrombolysis in myocardial infarction（TIMI）blood flow grading,the TIMI myocardial perfusion grading（TMPG）,the changes of N terminal B type natriuretic peptide（NT-pro BNP）levels and the finding of echocardiography in pre-and post-procedure were compared between two groups.Results The success rate of operation was all 100% in both two groups.Compared with control group,the incidence of no-reflow in research group significantly decreased（15.00% vs 31.67%,P 0.05）;the proportions of the Ⅲ grade TIMI blood flow grading（85.00% vs 68.33%,P 0.05）and the 3 grade TMPG（73.33% vs46.67%,P 0.05）significantly increased.Compared with pre-operation,the levels of NT-pro BNP one day after operation significantly elevated in both two groups（all P 0.05）,then gradually descended,and the decreased degree at postoperative each time point in research group were more obvious than those in control group（all P 0.05）.With going on of the time after operation,the levels of left ventricular ejection fraction（LVEF）increased gradually,and the levels of left ventricular end-diastolic volume（LVEDV）,left ventricular end-systolic volume index（LVESVI）,wall motion score index（WMSI）decreased gradually,increasingly,there were significant differences in their levels at 12 months after operation compared with pre-operation in both two groups（all P 0.05）.Compared with control group at each time point,LVEF levels increased in certain degrees and levels of LVEDV,LVESVI and WMSI decreased in certain degrees in research group,increasingly,there were significant differences in their levels at 12 months after procedure between two groups（all P 0.05）.Conclusion The high load atorvastatin use before primary PCI in AMI patients can effectively improve reperfusion of ischemic myocardium,prevent intraoperative no-reflow and improve cardiac functions.
出处
《中国临床研究》
CAS
2016年第2期199-203,共5页
Chinese Journal of Clinical Research
关键词
急性心肌梗死
经皮冠状动脉介入术
他汀类药物
高负荷
无复流
心功能
Acute myocardial infarction
Percutaneous coronary intervention
Statins
High load
No reflow
Cardiac function
