阿托伐他汀对急性ST段抬高型心肌梗死患者急诊经皮冠状动脉介入治疗术后无复流现象的作用
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摘要
目的探讨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经皮冠状动脉介入治疗(PCI)术后无复流现象的作用。方法选择急性ST段抬高型心肌梗死患者97例,均拟于12 h内行急诊PCI术,按PCI术前口服阿托伐他汀剂量的不同将其分为对照组46例与观察组51例。对照组术前给予常规剂量阿托伐他汀20 mg,观察组术前给予大剂量阿托伐他汀80 mg。观察2组冠状动脉心肌梗死溶栓治疗(TIMI)血流分级情况、术后无复流发生率以及ST段回落情况、术后7 d血清中超敏C反应蛋白(hs-CRP)与一氧化氮合酶(NOS)水平。结果术后,2组TIMI分级情况均较术前显著改善(P <0. 05);观察组术后无复流发生率(5. 88%)显著低于对照组(23. 91%),且ST段回落率(94. 12%)显著高于对照组(80. 43%)(P <0. 05);观察组术后7 d的hs-CRP水平(6. 85±1. 01) mg/L显著低于对照组(7. 56±1. 37) mg/L,而NOS水平(17. 21±6. 23) U/m L显著高于对照组(13. 56±4. 27) U/m L(P <0. 05)。结论 PCI术前服用较大剂量阿托伐他汀可显著改善PCI术后心肌血流再灌注,减少无复流现象,这可能与阿托伐他汀具有抗炎作用及改善内皮细胞功能有关。
Objective To investigate the effect of different doses of atorvastatin on no-reflow after acute percutaneous coronary intervention( PCI) in patients with acute ST-segment elevation myocardial infarction. Methods A total of 97 patients with acute ST-segment elevation myocardial infarction who were admitted to our hospital were enrolled. All patients underwent emergency PCI within 12 h. According to the different doses of oral atorvastatin before PCI,they were divided into control group and observation group. The control group( n = 46) receiveda routine dose of atorvastatin for20 mg before surgery,and the observation group( n = 51) received a large dose of atorvastatin for80 mg before surgery. The thrombin inhibition in myocardial infarction( TIMI) grading of coronary blood flow,the occurrence of postoperative no-reflow and S-segment fall,and the levels of serum high-sensitivity C-reactive protein( hs-CRP) and serum nitric oxide synthase( NOS) at 7 d after operation were observed. Results The TIMI score of the observation group was significantly improved than that of the control group( P < 0. 05). The incidence of no-reflow after operation was significantly lower than that of the control group( 5. 88% vs. 23. 91%),and the ST segment fall rate was significantly higher than that of the control group( 94. 12% vs. 80. 43%,P < 0. 05). The hs-CRP level was significantly lower in the observation group than that of the control group[( 6. 85 ± 1. 01) mg/L vs.( 7. 56 ± 1. 37) mg/L],and the NOS level was significantly higher than that of the control group[( 17. 21 ± 6. 23) U/m L vs.( 13.56 ±4.27) U/m L,P <0.05]. Conclusion Large doses of atorvastatin before PCI can significantly improve myocardial blood flow reperfusion after PCI and reduce no-reflow phenomenon,which may be related to the anti-inflammatory effect of atorvastatin and the improvement of endothelial cell function.
Objective To investigate the effect of different doses of atorvastatin on no-reflow after acute percutaneous coronary intervention( PCI) in patients with acute ST-segment elevation myocardial infarction. Methods A total of 97 patients with acute ST-segment elevation myocardial infarction who were admitted to our hospital were enrolled. All patients underwent emergency PCI within 12 h. According to the different doses of oral atorvastatin before PCI,they were divided into control group and observation group. The control group( n = 46) receiveda routine dose of atorvastatin for20 mg before surgery,and the observation group( n = 51) received a large dose of atorvastatin for80 mg before surgery. The thrombin inhibition in myocardial infarction( TIMI) grading of coronary blood flow,the occurrence of postoperative no-reflow and S-segment fall,and the levels of serum high-sensitivity C-reactive protein( hs-CRP) and serum nitric oxide synthase( NOS) at 7 d after operation were observed. Results The TIMI score of the observation group was significantly improved than that of the control group( P < 0. 05). The incidence of no-reflow after operation was significantly lower than that of the control group( 5. 88% vs. 23. 91%),and the ST segment fall rate was significantly higher than that of the control group( 94. 12% vs. 80. 43%,P < 0. 05). The hs-CRP level was significantly lower in the observation group than that of the control group[( 6. 85 ± 1. 01) mg/L vs.( 7. 56 ± 1. 37) mg/L],and the NOS level was significantly higher than that of the control group[( 17. 21 ± 6. 23) U/m L vs.( 13.56 ±4.27) U/m L,P <0.05]. Conclusion Large doses of atorvastatin before PCI can significantly improve myocardial blood flow reperfusion after PCI and reduce no-reflow phenomenon,which may be related to the anti-inflammatory effect of atorvastatin and the improvement of endothelial cell function.
引文
[1]刘强,杨小梅,韩乾国.急性ST段抬高型心肌梗死患者心电图特征临床分析[J].医学与哲学,2015,36(16):32-34.
[2]张文娟,张云盛.急性ST段抬高型心肌梗死的介入时机选择[J].天津医药,2017,45(11):1130-1134.
[3]孙宁卫,张运,李曼.老年ST段抬高型急性心肌梗死患者急诊冠状动脉介入术后无复流的危险因素[J].心血管康复医学杂志,2017,26(1):12-15.
[4]李勇.他汀类药物与动脉粥样硬化性心血管疾病一级预防:我们所处何处该有何为[J].浙江医学,2016,38(8):521-524,530.
[5]中华医学会心血管病学分会,中华心血管病杂志编辑委员会.急性ST段抬高型心肌梗死诊断和治疗指南[J].中华心血管病杂志,2015,43(5):380-393.
[6]王辉,刘震宇,张抒扬,等.高龄急性ST段抬高型心肌梗死患者行直接经皮冠状动脉介入治疗的近期预后[J].中华老年心脑血管病杂志,2015,17(10):1028-1032.
[7]郭自同,沈鑫,王钊,等.逆向溶栓联合PCI术对急性ST段抬高型心肌梗死的疗效观察[J].中国急救医学,2017,37(5):454-457.
[8]车志,黄伟光,宋华锋. PCI术后无复流现象的预测因素研究进展[J].广东医学,2016,37(24):3781-3783.
[9]杨培根,单瑞,程爱娟,等.他汀类药物治疗对2型糖尿病并ST段抬高急性心肌梗死患者磷脂酶A2和心功能的影响[J].中华老年医学杂志,2015,34(8):854-857.
[10]杜海燕,方振威,林阳.他汀类药物防治动脉粥样硬化性心血管疾病相关指南解读及其临床应用现状分析[J].中国医院用药评价与分析,2015,15(2):148-153.
[11]张艳辉.不同他汀类药物治疗早发冠心病急性心肌梗死患者的近期临床随访研究[J].实用临床医药杂志,2016,20(15):120-121.
[12]郭国勋,赵友民,柴建文,等.阿托伐他汀钙预治疗对急性冠脉综合征患者介入后血流灌注及预后的影响[J].中国循证心血管医学杂志,2015,7(1):43-46.
[13]刘庆,杨勇,马东星,等. STEMI患者急诊PCI术前阿托伐他汀强化治疗对ST段回落及内皮功能的影响[J].中国急救复苏与灾害医学杂志,2017,12(7):639-642.
[14]田怡,欧阳松,王家祺,等. Hcy,hs-CRP与急性脑梗死患者颈动脉粥样硬化关系的研究[J].现代生物医学进展,2016,16(20):3853-3855,3859.
[15]汤玮,赵冬婧,胡硕强,等.急性ST段抬高型心肌梗死患者急诊PCI术前80 mg阿托伐他汀治疗对炎性因子及心功能的影响[J].中华临床医师杂志:电子版,2016,10(15):2245-2250.
[16]徐晓蓉,李奎宝,王攀,等.阿托伐他汀对急性ST段抬高型心肌梗死患者血浆内皮素及血小板功能的影响[J].中华内科杂志,2016,55(12):932-936.
[2]张文娟,张云盛.急性ST段抬高型心肌梗死的介入时机选择[J].天津医药,2017,45(11):1130-1134.
[3]孙宁卫,张运,李曼.老年ST段抬高型急性心肌梗死患者急诊冠状动脉介入术后无复流的危险因素[J].心血管康复医学杂志,2017,26(1):12-15.
[4]李勇.他汀类药物与动脉粥样硬化性心血管疾病一级预防:我们所处何处该有何为[J].浙江医学,2016,38(8):521-524,530.
[5]中华医学会心血管病学分会,中华心血管病杂志编辑委员会.急性ST段抬高型心肌梗死诊断和治疗指南[J].中华心血管病杂志,2015,43(5):380-393.
[6]王辉,刘震宇,张抒扬,等.高龄急性ST段抬高型心肌梗死患者行直接经皮冠状动脉介入治疗的近期预后[J].中华老年心脑血管病杂志,2015,17(10):1028-1032.
[7]郭自同,沈鑫,王钊,等.逆向溶栓联合PCI术对急性ST段抬高型心肌梗死的疗效观察[J].中国急救医学,2017,37(5):454-457.
[8]车志,黄伟光,宋华锋. PCI术后无复流现象的预测因素研究进展[J].广东医学,2016,37(24):3781-3783.
[9]杨培根,单瑞,程爱娟,等.他汀类药物治疗对2型糖尿病并ST段抬高急性心肌梗死患者磷脂酶A2和心功能的影响[J].中华老年医学杂志,2015,34(8):854-857.
[10]杜海燕,方振威,林阳.他汀类药物防治动脉粥样硬化性心血管疾病相关指南解读及其临床应用现状分析[J].中国医院用药评价与分析,2015,15(2):148-153.
[11]张艳辉.不同他汀类药物治疗早发冠心病急性心肌梗死患者的近期临床随访研究[J].实用临床医药杂志,2016,20(15):120-121.
[12]郭国勋,赵友民,柴建文,等.阿托伐他汀钙预治疗对急性冠脉综合征患者介入后血流灌注及预后的影响[J].中国循证心血管医学杂志,2015,7(1):43-46.
[13]刘庆,杨勇,马东星,等. STEMI患者急诊PCI术前阿托伐他汀强化治疗对ST段回落及内皮功能的影响[J].中国急救复苏与灾害医学杂志,2017,12(7):639-642.
[14]田怡,欧阳松,王家祺,等. Hcy,hs-CRP与急性脑梗死患者颈动脉粥样硬化关系的研究[J].现代生物医学进展,2016,16(20):3853-3855,3859.
[15]汤玮,赵冬婧,胡硕强,等.急性ST段抬高型心肌梗死患者急诊PCI术前80 mg阿托伐他汀治疗对炎性因子及心功能的影响[J].中华临床医师杂志:电子版,2016,10(15):2245-2250.
[16]徐晓蓉,李奎宝,王攀,等.阿托伐他汀对急性ST段抬高型心肌梗死患者血浆内皮素及血小板功能的影响[J].中华内科杂志,2016,55(12):932-936.