大剂量或小剂量阿托伐他汀对 ST 段抬高型心肌梗死患者急诊经皮冠状动脉介入术后无复流现象的影响

摘要

Obj cetive To investigate the clinical effect of high d-ose or low-dose of atorvastatin on no-flow phenomenon after percutaneous coronary intervention ( PCI)in patients with acute ST-elevation myocardial infarc-tion. Methods Totally 64 patients who were diagnosed of ST-elevation myocardial infarction and received PCI from October 2011 to March 2013 in Peoples′Hospital of Jieyang city were randomly divided into high-dose atorv-astatin group ( atorvastatin 80 mg, n=32 ) and low-dose atorvastatin group ( atorvastatin 20 mg, n=32 ) .The thrombolysis in myocardial infarction ( TIMI) myocardial perfusion grade , electrocardiogram and major adverse car-diovascular event(MACE) were compared between the two groups.Results The rate of (MACE) was 6.2%(2/32) in high-dose atorvastatin group, compared with 37.5%(12/32) in low-dose atorvastatin group (χ2 =9.143, P<0.05).Ratio of TIMI 0, TIMI 1 in patients with low-dose atorvastatin group was 28.1%(7/32) and 37.5%(12/32), respectively.Ratio of TIMI 0, TIMI 1 in patients with low-dose atorvastatin group was 6.3%(2/32) and 3.1%(1/32), respectively;the high-dose atorvastatin group was significantly lower than the low -dose atorvastatin group(χ2=5.379,11.680, P<0.05).TIMI 2, TIMI 3 rate in low-dose atorvastatin group was 21.8%(7 /32) and 12.5%(4/32), respectively.TIMI 2, TIMI 3 rate in high-dose atorvastatin group were 46.9%(15/32) and 43.8%(14/32), respectively;the high-dose atorvastatin group were significantly higher than the low-dose atorvastatin group (χ2 =4.433, 7.729, both P<0.05).ST elevation was (0.15 ±0.04)mm in the low-dose atorvastatin group, as was (0.06 ±0.02)mm in the high-dose atorvastatin group;high-dose atorvastatin group was significantly lower than low-dose atorvastatin group (t=3.323 , P<0.05).ST down was (0.22 ± 0.07)mm in the low-dose atorvastatin group, as was (0.07 ±0.02)mm in the high-dose atorvastatin group;high-dose atorvastatin group was significantly lower than low-dose atorvastatin group (t=3.451, P<0.05).Total cho-lesterol was (5.4 ±0.4)mmol/L in the low-dose atorvastatin group, as was(4.4 ±0.3)mmol/L in the high-dose atorvastatin group; high-dose atorvastatin group was significantly lower than low -dose group (t =3.310, P <0.05).TG was (1.98 ±0.16 )mmol/L in the low-dose atorvastatin group, as was (1.38 ±0.21)mmol/L in the high-dose atorvastatin group; high-dose atorvastatin group was significantly lower than low-dose atorvastatin group (t=3.962, P<0.05).LDL-C was (3.38 ±0.41) mmol/L in the low-dose atorvastatin group; it was (2.53 ± 0.15)mmolL/in the high-dose atorvastatin group;high-dose atorvastatin group was significantly lower than low -dose atorvastatin group(t =3.385, P<0.05).HDL-C was (1.16 ±0.11)mmol/L in the low-dose atorvastatin group;it was (1.49 ±0.14)mmol/L in the high-dose atorvastatin group;high-dose atorvastatin group was significantly higher than low-dose atorvastatin group(t=3.293, P<0.05).Conclusion Atorvastatin can improve myocardial perfusion and reduce no-reflow phenomenon after PCI .%目的：评价大剂量或小剂量阿托伐他汀对ST段抬高型心肌梗死（ STEMI ）患者急诊经皮冠状动脉介入（ PCI）后无复流现象的影响。方法选取2011年10月至2013年3月广东省揭阳市人民医院收治的STEMI并行急诊PCI术的患者共64例按例随机数字表法分为大剂量阿托伐他汀组和小剂量阿托伐他汀组，每组32例。大剂量阿托伐他汀组给予80 mg阿托伐他汀，口服；小剂量阿托伐他汀组给予20 mg阿托伐他汀，口服；对2组患者心肌梗死溶栓试验（ TIMI ）血流分级、心电图及主要不良心血管事件（MACE）发生比较。结果大剂量阿托伐他汀组MACE发生率为6．2％（2/32），小剂量阿托伐他汀组MACE发生率为37．5％（12/32），2组比较差异有统计意义（χ2＝9．143，P＜0．05）。小剂量阿托伐他汀组TIMI 0级、TIMI 1级患者比例分别为28．1％（9/32）、37．5％（12/32），大剂量阿托伐他汀组TIMI 0级、TIMI 1级患者比例分别为6．3％（2/32）、3．1（1/32）％，大剂量阿托伐他汀组患者TIMI 0级、TIMI 1级比例明显低于小剂量阿托伐他汀组（χ2＝5．379、11．680，均P＜0．05）。小剂量阿托伐他汀组TIMI 2级、TIMI 3级患者比例分别为21．8％（7/32）、12．5％（4/32），大剂量阿托伐他汀组TIMI 2级、TIMI 3级患者比例分别为46．9％（15/32）、43．8％（14/32），大剂量阿托伐他汀组患者TIMI 2级、TIMI 3级比例明显高于小剂量阿托伐他汀组（χ2＝4．433、7．729，均P＜0．05）。小剂量阿托伐他汀组ST段抬高为（0．15±0．04）mm，大剂量阿托伐他汀组ST段抬高为（0．06±0．02）mm，大剂量阿托伐他汀组明显低于小剂量阿托伐他汀组（t＝3．323， P＜0．05）；小剂量阿托伐他汀组ST段压低为（0．22±0．07）mm，大剂量阿托伐他汀组ST段压低为（0．07±0．02）mm，大剂量阿托伐他汀组明显低于小剂量阿托伐他汀组（t＝3．451， P＜0．05）；小剂量阿托伐他汀组缺血损伤导联平均个数为（4．87±1．24）个，大剂量阿托伐他汀组缺血损伤导联平均个数为（1．53±0．63）个，大剂量阿托伐他汀组明显低于小剂量阿托伐他汀组（t＝3．604， P＜0．05）。小剂量阿托伐他汀组总胆固醇为（5．4±0．4）mmol/L，大剂量阿托伐他汀组总胆固醇为（4．4±0．3）mmol/L，大剂量阿托伐他汀组明显低于小剂量阿托伐他汀组（t ＝3．310， P ＜0．05）；小剂量阿托伐他汀组三酰甘油为（1．98±0．16）mmol/L，大剂量阿托伐他汀组三酰甘油为（1．38±0．21）mmol/L，大剂量阿托伐他汀组明显低于小剂量阿托伐他汀组（t＝3．962， P＜0．05）；小剂量阿托伐他汀组低密度脂蛋白胆固醇（LDL-C）为（3．38±0．41）mmol/L，大剂量阿托伐他汀组LDL-C为（2．53±0．15）mmol/L，大剂量阿托伐他汀组明显低于小剂量阿托伐他汀组（t＝3．385， P ＜0．05）；小剂量阿托伐他汀组高密度脂蛋白胆固醇（ HDL-C）为（1．16±0．11）mmol/L，大剂量阿托伐他汀组HDL-C为（1．49±0．14）mmolL/，大剂量阿托伐他汀组明显高于小剂量阿托伐他汀组（t＝3．293， P＜0．05）。结论大剂量阿托伐他汀可有效改善STEMI患者急诊PCI术后无复流现象。