术前强化剂量阿托伐他汀口服对心肌梗死患者PCI术后无复流、心功能及预后的影响

摘要

目的 探讨术前强化剂量阿托伐他汀口服对心肌梗死患者经皮冠状动脉介入治疗(PCI)术后无复流、心功能及患者预后的影响.方法 选择行PCI治疗的心肌梗死患者96例,将其随机分为常规剂量组、强化剂量组各48例.两组均给予常规治疗,常规剂量组在此基础上术前即刻口服20 mg阿托伐他汀,强化剂量组口服80 mg阿托伐他汀.观察两组术中心肌梗死溶栓血流分级(TIMI)、无复流发生率;比较两组术前、术后3d、术后1个月、术后3个月、术后6个月血清N端B型利钠肽前体(NT-proBNP)水平及心功能指标[左心室舒张末期内径(LVEDD)、左心室收缩末期内径(LVESD)、左心室射血分数(LVEF)];观察两组治疗过程中的不良反应发生情况及术后1年心血管事件发生情况.结果 强化剂量组术中无复流发生率为12.50％,低于常规剂量组的31.25％ (P＜0.05).与本组术前相比,治疗后强化剂量组、常规剂量组两组术后3d、术后1个月、术后3个月、术后6个月血清NT-proBNP水平高,LVEF高(P均＜0.05).与常规剂量组术后3个月、术后6个月相比,强化剂量组血清NT-proB-NP水平低,LVEDD小,LVESD小,LVEF高(P均＜0.05).常规剂量组不良反应发生率为4.17％,强化剂量组为8.33％,两组比较P＞0.05.随访1年,强化剂量组心血管事件发生率为2.08％,低于常规剂量组的8.33％,但两组比较P＞0.05.结论 术前80 mg强化剂量阿托伐他汀口服,可以降低急性心肌梗死患者PCI术后无复流发生率,促进患者心功能恢复,改善患者预后.%Objective To investigate the effects of preoperative oral administration of intensive-dose atorvastatin on no-reflow,cardiac function,and prognosis of patients with myocardial infarction after percutaneous coronary intervention (PCI).Methods Ninety-six patients with myocardial infarction who received PCI were randomly divided into the routinedose group and intensive-dose group with 48 cases in each group.The patients of the two groups both received the conventional treatment,and on this basis,the routine-dose group received oral administration of 20 mg atorvastatin immediately before the operation,while the intensive-dose group received 80 mg.The blood flow fractionation of thrombolysis in myocardial infarction (TIMI) and the rate of no-reflow during the operation were observed.The levels of N terminal type B natriuretic peptide (NT-proBNP) and cardiac function index [left ventricular end-diastolic diameter (LVEDD),left ventricular end-systolic diameter (LVESD),and left ventricular ejection fraction (LVEF)] of the two groups before operation and 3 d,1 month,3 months,and 6 months after operation were compared.The incidence of adverse reactions during the treatment and the incidence of cardiovascular events within 1 year after the operation were observed in the two groups.Results The rate of no-reflow in the intensive-dose group was 12.50％,which was significantly lower than that (31.25％) in the routine-dose group (P ＜ 0.05).The level of serum NT-proBNP and the LVEF in the two groups at 3 d,1 month,3 months,and 6 months after operation were significantly higher than those before operation (both P ＜ 0.05).The level of serum NT-proBNP,LVEDD,and LVESD decreased,but LVEF increased in the intensive-dose group at 3 and 6 months after operation as compared with those in the routine-dose group (all P ＜ 0.05).The adverse reaction rate was 4.17％ in the routinedose group,versus 8.33％ in the intensive-dose group;after 1-vear follow-up,the incidence of cardiovascular events was 2.08％ in the intensive-dose group,which was lower than that (8.33％) of the routine-dose group;no statistical differences were found between these two groups (both P ＞ 0.05).Conclusion The preoperative oral administration of 80 mg intensive-dose atorvastatin can reduce the rate of no-reflow after PCI,promote the recovery of cardiac function,and improve the prognosis of patients with acute myocardial infarction.