围术期强化瑞舒伐他汀钙治疗对急性心肌梗死直接经皮冠状动脉介入治疗中冠状动脉血流的影响

The influence of intensive treatment of rosuvastatin in perioperative period on coronary blood flow during primary percutaneous coronary intervention for acute myocardial infarction

目的评估围手术期强化瑞舒伐他汀钙治疗对急性心肌梗死直接经皮冠状动脉介入治疗(PPCI)靶血管开通后即刻冠脉血流的影响。方法收集2018年6月至2019年6月诊断为急性ST段抬高型心肌梗死(STEMI)接受直接PCI治疗的患者122例,根据术前是否强化瑞舒伐他汀治疗分为研究组62例和对照组60例。研究组术前30 min内开始服用瑞舒伐他汀钙20 mg,连续服用7天,20 mg/d,后以10 mg/d长期维持;对照组术前不服用任何他汀类药物,PCI后开始服用瑞舒伐他汀钙10 mg/d,长期维持。观察PPCI靶血管开通后TIMI血流、校正TIMI帧数(Corrected TIMI frame count,CTFC)、住院期间心肌酶学、心电图以及出院后30天超声心动图情况。结果靶血管开通后,研究组CTFC及CTFC大于100帧者(相当于TIMI 0级)均低于对照组(P<0.05)。治疗后,两组肌钙蛋白I、肌酸激酶同工酶、B型利钠肽水平均低于治疗前,梗死相关导联ST段抬高总和明显降低,且研究组低于对照组(均P<0.05);两组超声心动图中左室射血分数、左室舒张末期容积比较,差异无统计学意义(P>0.05)。结论围术期瑞舒伐他汀钙治疗对急性ST段抬高性心肌梗死直接经皮冠状动脉介入治疗可有效的改善冠脉即刻血流,增加心肌组织灌注,具有较好的安全性。

Objective To evaluate the influence of intensive rosuvastatin treatment in perioperative period on reperfusion of coronary artery in patients with acute myocardial infarction undergoing primary percutaneous coronary intervention(PPCI).Methods One hundred and twenty-two patients with ST-segment elevation myocardial infarction(STEMI)received PPCI in the First Affiliated Hospital of Xi'an Jiaotong University and Tangxian Hospital of Traditional Chinese Medicine from June 2018 to June 2019 were enrolled.They were randomly divided into study group(n=62)and control group(n=60)according to whether treatment of rosuvastatin during the perioperative period.The patients in the study group began to take 20 mg of rosuvastatin within 30 min before PPCI and continued to take 20 mg of rosuvastatin everyday for seven days after PCI.Then,they turned to take 10 mg of rosuvastatin everyday for long-term maintenance.The control group didn't take any statins drugs before operation and only began to take 10 mg of rosuvastatin everyday after operation for long-term maintenance.Study outcomes included immediate thrombolysis in myocardial infarction(TIMI)flow and corrected TIMI frame count(CTFC)by angiography once the target lesion was opened and the serum levels of creatine phosphokinase-isoenzyme-MB(CK-MB),cardiac troponin I(cTNI),B type natriuretic peptide(BNP)as well as echocardiogram in 30 days.Results After the target vessel was opened,the CTFC and CTFC greater than 100 frames in the study group(equivalent to TIMI 0 grade)were lower than those in the control group(P<0.05).After treatment,the levels of cTNI,CK-MB,and BNP in the two groups were lower than before treatment,and the total ST elevation in infarction-related leads was significantly reduced,and the study group was lower than the control group(P<0.05).There was no statistically significant in the comparison of left ventricular ejection fraction and left ventricular end-diastolic volume in echocardiography between the two groups(P>0.05).Conclusion The intensive rosuvastatin treatment in patients with STEMI undergoing primary PCI is safe and can effectively improve the coronary immediate blood flow and increase the myocardial tissue perfusion.