术前不同剂量阿托伐他汀对行直接经皮冠状动脉介入治疗的急性ST段抬高心肌梗死患者心肌灌注的影响  

Effects of different preloading dosage of atorvastatin on myocardial perfusion in patients with STsegment elevation myocardial infarction receiving primary percutaneous intervention

作　　者：周鑫[1] 向定成[1] 张金霞[1] 阮云军[1] 杨靓[1] 龚志华[1] 文艳飞[1] 夏丽莎[1] 曹志英[1] 

机构地区：[1]广州军区广州总医院心血管内科,广东广州510010

出　　处：《中国介入心脏病学杂志》2015年第9期490-493,共4页Chinese Journal of Interventional Cardiology

基　　金：广州市科技计划专项(2014Y2-00068);广东省科技计划项目(2012B031800182);广东省科技计划重大项目(2012A080104020);广州市重点实验室建设专项(穗科信字[2013]163-15)

摘　　要：目的探讨在首次医疗接触时给予不同剂量阿托伐他汀对接受直接经皮冠状动脉介入治疗(primary percutaneous coronary intervention,PPCI)的急性ST段抬高心肌梗死(ST-segment elevation myocardial infarction,STEMI)患者梗死相关区域心肌灌注水平的影响。方法纳入118例行PPCI的STEMI患者,在首次医疗接触时给予单次不同剂量阿托伐他汀,随机分为A组(给予阿托伐他汀80 mg,30例)、B组(给予阿托伐他汀40 mg,28例)、C组(给予阿托伐他汀20 mg,30例)和D组(给予安慰剂,30例),而后立即行冠状动脉造影及PPCI,术后测量并记录冠状动脉TIMI血流分级、心肌灌注分级(myocardial blush grade,MBG)、术后90 min心电图ST段回落程度(ST-segment resolution,STR)。结果四组患者梗死相关血管术前或术后的TIMI血流分级、MBG分别比较,差异均无统计学意义(均P>0.05)。四组患者术后90 min STR值分别为:A组(55.77±30.55)%,B组(53.66±28.14)%,C组(50.48±24.91)%,D组(42.03±30.63)%,组间比较,差异均无统计学意义(F=1.324,P=0.270),但A组至D组STR值总体均数呈逐渐降低趋势。结论对于接受PPCI治疗的STEMI患者,在首次医疗接触时给予负荷剂量的阿托伐他汀进行预处理未能改善PCI术后的冠状动脉血流及心肌灌注水平。Objective To investigate the effects of different preloading dosage of atorvastatin at the location of first medical consult on myocardial perfusion in patients with acute ST segment elevation myocardial infarction（STEMI） undergoing primary percutaneous coronary intervention（PPCI）.Methods A total of 118 patients with STEMI were randomized into group A（n = 30）,group B（n = 28）,group C（n =30） and group D（n = 30） at the location of first medical consult with different preloading dosage of atorvastatin 80 mg,40 mg,20 mg and placebo respectively together with dual-antiplatelet therapy with aspirin 300 mg and clopidogrel 600 mg.All of the patients were prescribed with atorvastatin 20 mg/day,aspirin 100 mg/day and clopidogrel 75 mg/day after primary PCI.TIMI grade flow after PPCI,myocardial blush grade（MBG） and degree of ST-segment resolution（STR） at 90 mins after PPCI were compared between the four groups.Results There were no any significant differences in Thrombolysis In Myocardial Infarction（TIMI） flow and Myocardial Blush Grade（MBG） before or after PCI among the four groups（all P〉0.05）.STR at 90 mins after PCI was not statistically different among the four groups（all P 0.05）.Conclusions For Chinese STEMI patients,pretreated with different dosage of atorvastatin at the location of first medical consult did not improve coronary flow and myocardial perfusion after primary PCI.

关 键 词：阿托伐他汀 急性心肌梗死 经皮冠状动脉介入治疗 心肌灌注 

分 类 号：R542.22[医药卫生—心血管疾病]