替罗非班联合大剂量阿托伐他汀对急诊PCI术中冠状动脉血流恢复的影响

摘要

目的 探讨替罗非班联合大剂量阿托伐他汀对急性ST段抬高型心肌梗死(STEMI)患者急诊PCI术中冠状动脉血流恢复的影响.方法 入选2013年1月~2014年10月在济宁医学院附属医院心内科就诊的STEMI患者452例,其中男性277例,女性175例,年龄范围50~76岁.随机分为常规治疗组(151例)、替罗非班组(151例)及联合治疗组(150例).常规治疗组常规治疗,术前嚼服阿托伐他汀钙20 mg.替罗非班组术前在常规治疗基础上加用替罗非班,静脉推注10 ml(0.5 mg),随后以0.4μg/(kg·min)泵入,30 min后改为0.1μg/(kg·min),持续24 h.联合治疗组在替罗非班组基础上阿托伐他汀钙改用80 mg顿服.成功置入支架后1 min、5 min以心肌梗死溶栓试验(thrombolysis in myocardial infarction,TIMI)分级标准及TIMI帧数判断冠状动脉血流情况.术后即刻及术后2 h所有患者均行心电图检查,记录ST段抬高幅度.结果 联合治疗组支架置入后1 min、5 min TIMI分级较常规治疗组和替罗非班组均改善,差异有统计学意义(P均<0.05).支架置入后1 min和5 min,与常规治疗组和替罗非班组比较,联合治疗组TIMI帧数减少,数值为[(89.2±13.4)桢vs.(66.5±8.9)桢],[(77.8±10.9)桢vs.(66.5±8.9)桢],[(62.9±10.1)桢vs.(49.8±7.5)桢],[(55.3±9.1)桢vs.(49.8±7.5)桢],差异有统计学意义(P均<0.05).急诊PCI术后即刻和2 h,联合治疗组ST段抬高幅度较常规治疗组和替罗非班组回落,[(0.25±0.12)mVvs.(0.32±0.13)mV],[(0.25±0.12)mVvs.(0.27±0.11)mV],[(0.16±0.08)mVvs.(0.20±0.12)mV],[(0.16±0.08)mVvs.(0.18±0.09)mV],差异有统计学意义(P均<0.05).结论 替罗非班联合大剂量阿托伐他汀较单独替罗非班及常规治疗能更有效地改善STEMI患者急诊PCI术中冠状动脉血流.%Objective To investigate the influence of tirofiban combining high-dose atorvastatin on coronary artery flow recovery during emergency percutaneous coronary intervention (PCI) in patients with acute ST-segment elevation myocardial infarction (STEMI).Methods STEMI patients (n=452, male 277, female 175 and aged from 50 to 76) were chosen from Jan. 2013 to Oct. 2014, and then randomly divided into routine group (n=151), tirofiban group (n=151) and combining group (n=150). The routine group was given routine therapy and atorvastatin orally before PCI, tirofiban group was given routine therapy and tirofiban and combining group was given routine therapy, tirofiban and atorvastatin. After PCI for 1 min and 5 min, the coronary artery flow was reviewed with thrombolysis in myocardial infarction (TIMI) grading and TIMI frame count (TFC). All patients were given electrocardiogram (ECG) examination for recording ST-segment elevation degree immediately and 2 h after PCI.Results TIMI grading was improved in combining group compared with routine group and tirofiban group after PCI for 1 min and 5 min (all P<0.05). TFC decreased in combining group compared with routine group and tirofiban group after PCI for 1 min and 5 min [(89.2±13.4)vs. (66.5±8.9)], [(77.8±10.9)vs. (66.5±8.9)], [(62.9±10.1)vs. (49.8±7.5) ], [(55.3±9.1) vs. (49.8±7.5), all P<0.05]. ST-segment resolution was more significant in combining group compared with routine group and tirofiban group immediately and 2 h after PCI [(0.25±0.12) mVvs. (0.32±0.13) mV], [(0.25±0.12) mV vs. (0.27±0.11) mV], [(0.16±0.08) mVvs. (0.20±0.12) mV], [(0.16±0.08) mVvs. (0.18±0.09) mV, all P<0.05]. Conclusion Tirofiban combining high-dose atorvastatin can more effectively improve coronary artery flow than only tirofiban or routine therapy in STEMI patients during PCI.