不同剂量阿托伐他汀对急性ST段抬高型心肌梗死患者急诊PCI术后无复流现象发生和心功能的影响

Effects of different doses of Atorvastatin on no-reflow phenomenon and cardiac function in patients with acute ST-segment elevation myocardial infarction after emergency PCI

目的观察不同剂量阿托伐他汀对急性ST段抬高型心肌梗死(STEMI)患者急诊经皮冠状动脉内介入(PCI)术后无复流现象(NRP)和心功能的影响。方法选择2017年4月至2018年12月济南市人民医院收治的STEMI患者100例进行前瞻性研究,均行PCI术治疗,根据给予阿托伐他汀剂量的不同将患者分为低剂量组和高剂量组,每组各50例。低剂量组患者给予阿托伐他汀40 mg/d;高剂量组患者给予阿托伐他汀80 mg/d。观察两组患者的心肌梗死溶栓治疗(TIMI)血流分级、NRP和相关TIMI帧数(cTFC)发生率,检测血液的氨基末端脑钠尿肽(NT-proBNP)、心肌肌钙蛋白T(cTnT)和超敏C反应蛋白(hs-CRP)水平,评估术前及术后左心室射血分数(LVEF)、心脏指数(CI)、心排血量(CO)。结果高剂量组患者TIMI血流分级0+Ⅰ+Ⅱ级发生率、NRP、cTFC及术后血清NT-proBNP、cTNI和hsCRP分别为4. 00%(2/50)、4. 00%(2/50)、(44. 15±2. 98)帧、(411. 38±30. 15)μg/L、(0. 53±0. 17)μg/L、(22. 45±0. 64) mg/L,低于低剂量组[18. 00%(9/50)、16. 00%(8/50)、(49. 07±3. 26)帧、460. 93±32. 05)μg/L、(0. 92±0. 15)μg/L、(29. 30±0. 62) mg/L],差异有统计学意义(P <0. 05)。高剂量组患者术后LVEF为(52. 59±0. 76)%,高于低剂量组[(50. 05±0. 82)%],差异有统计学意义(P <0. 05)。结论 STEMI患者行PCI术治疗时,给予高剂量阿托伐他汀,能够减少NRP的发生,显著改善心功能。

Objective To observe the effects of different doses of atorvastatin on no-reflow( NRP) and cardiac function in patients with acute ST-segment elevation myocardial infarction( STEMI) after emergency percutaneous coronary intervention( PCI). Methods 100 patients with STEMI admitted to Jinan People’s Hospital from April 2017 to December 2018 were enrolled in this prospective study. All patients underwent PCI. According to different doses of Atorvastatin,the patients were divided into low-dose group and high-dose group,50 patients in each group. Patients in low-dose group were given Atorvastatin 40 mg/d,while high dose group given 80 mg/d. In each group,the thrombolysis in myocardial infarction( TIMI) blood flow grading,NRP and corrected TIMI Frame Count( cTFC) were observed,the N terminal pro B type natriuretic peptide( NT-proBNP),cardiac troponin T( cTnT) and high-sensitivity C-reactive protein( hs-CRP) were detected,so as to evaluate the preoperative and postoperative left ventricular ejection fraction( LVEF),cardiac index( CI),and cardiac output( CO). Results In high-dose group,the incidence of TIMI 0 +Ⅰ + Ⅱ,NRP,cTFC,postoperative serum NT-proBNP,cTnT and hs-CRP were 4. 00%( 2/50),4. 00%( 2/50),( 44. 15 ± 2. 98) frames,( 411. 38 ± 30. 15) μg/L,( 0. 53 ± 0. 17) μg/L,( 22. 45 ± 0. 64) mg/L,respectively,and lower than those in low-dose group [18. 00%( 9/50),16. 00%( 8/50),( 49. 07 ± 3. 26) frames,460. 93 ± 32. 05]μg/L,( 0. 92 ± 0. 15) μg/L,( 29. 30 ±0. 62) mg/L]. The postoperative LVEF in high-dose group was( 52. 59 ± 0. 76) %,higher than that in low-dose group [( 50. 05 ± 0. 82) % ],and the difference was statistically significant( P < 0. 05). Conclusion High-dose atorvastatin in patients with STEMI undergoing PCI can reduce the incidence of NRP and significantly improve cardiac function.