大剂量阿托伐他汀对急性ST段抬高型心肌梗死患者急诊PCI治疗后冠脉无复流现象的作用

Effects of high dose loading Atorvastatin in acute ST-elevation myocardial infarction patients with no reflow phenomenon after primary percutaneous coronary intervention

目的探讨大剂量阿托伐他汀对急性sT段抬高型心肌梗死急诊PCI术后冠脉无复流现象的影响。方法选择诊断为急性sT段抬高型心肌梗死并行急诊PCI治疗的患者60例，术前即刻分别给予阿托伐他汀（立普妥）20mg（对照组，n=30）和80mg（负荷组，n=30），评价TIMI心肌灌注分级（TMPG）、单导联sT段下降幅度、术前及术后超敏C反应蛋白（hs-CRP）及术后6个月超声心动图评价心脏功能情况。结果与对照组相比，负荷组的TMPG2～3级者显著多于对照组（P=0．01），sT段回落幅度明显增大（P=0．001），术前、术后48h血浆hs-CRP降低（P〈0．05），心功能明显改善（P〈0．05），围手术期CK-MB及CTn-I峰值水平。结论大剂量阿托伐他汀能够明显改善PCI术后心肌血流灌注，防止无复流的发生，并可以改善远期心脏结构和功能。

Objective To investigate the effects of high dose loading atorvastatin in ST-elevation myocardial infarction patients with no reflow phenomenon after PCI. Methods We chose 60 patients who were diagnosed as ST-elevation myocardial infarction and received PCI, and divided them into two groups ： control group （ receved 20 mg Atorvastatin （Lipitor） before the PCI, n = 30） and loading group （ re ceived 80 mg Atorvastatin before the PCI, n = 30）, and myocardial TMP grade （TMPG）, electrocardiographic sign of myocardial reperfu- sion,the hs-CRP before and after the PCI,echocardiogram examinations 6 months after the AMI were analyzed. Results Compared with the control group, the TMPG was significantly improved（ P = 0.01 ）, ST segment resolution was faster（ P = 0.001 ）, the density of hs-CRP was lower in the loading group（ P 〈 0.05 ） ,and cardiac function and configuration were better（ P 〈 0.05 ）. CK-MB and CTn-I peak level during operation period. Conclusions High does loading atorvastatin can improve myocardial perfusion and reduce no-reflow phenome non after PCI,and can improve the cardiac configuration and function.