阿托伐他汀联合替罗非班治疗对急性ST段抬高型心肌梗死直接PCI术中无复流现象的影响

目的：探讨术前服用大剂量阿托伐他汀联合冠状动脉内注射替罗非班治疗对急性 ST段抬高型心肌梗死（STEMI）患者直接PCI 术中无复流现象（NRP）的影响。方法将94例发病12 h内行直接PCI 术中出现NRP的STEMI患者按照随机双盲法分为2组：阿托伐他汀组（54例）和对照组（40例）。2组行直接PCI术前均采用氯吡格雷片300 mg、拜阿司匹林肠溶片300 mg顿服。在此基础上，阿托伐他汀组加用阿托伐他汀钙80 mg口服。2组术中出现NRP时，经指引导管冠状动脉内注入替罗非班10μg·kg-1，5 min注射完毕。观察2组患者PCI术中出现NRP前（D0）、PCI术结束前末次（D1）的心肌梗死溶栓治疗（TIMI）血流分级（TIMI 0级、1-2级、3级），TIMI心肌灌注分级（TMPG 0级、1-2级和3级），校正TIMI 帧数（cTFC）、ST 段回落幅度（STR）及术前，术后12、24和48 h血清心肌肌钙蛋白 I （cTnI）水平的情况。结果2组D0、D1时TIMI 0级，D0时TIMI 1-2级、TIMI 3级、TMPG 3级，D1时TMPG 1-2级比例比较差异均无统计学意义（均P＞0.05）；2组D1时TIMI 1-2级、TIMI 3级、TMPG 0级、TMPG 1-2级、TMPG 3级与D0时比较差异有统计学意义（均P＜0.05）；阿托伐他汀组D1时TIMI 1-2级，D0、D1时TMPG 0级比例均低于对照组， D1时TIMI 3级、D0时TMPG 1-2级、D1时TMPG3级比例均高于对照组（均P＜0.05）。阿托伐他汀组STR＜30%比例低于对照组（P＜0.05）；2组术后12、24和48 h cTnI水平均明显低于术前，阿托伐他汀组均明显低于对照组（均P＜0.05）。结论 PCI术前预先使用大剂量阿托伐他汀未能减少术中NRP的发生。术前预先使用大剂量阿托伐他汀可以改善NRP 出现后心肌灌注，联合冠状动脉内注射替罗非班较单纯冠状动脉内注射替罗非班在改善NRP方面更明显。

Effect of Atorvastatin Combined with Tirofiban on No-Reflow Phenomenon during Primary Percutaneous Coronary Intervention in Patients with Acute ST Segment Elevation Myocardial Infarction

Objective To investigate the effect of preoperative administration of high -dose atorvastatin combined with intracoronary tirofiban on no-reflow phenomenon （NRP） during primary percutaneous coronary intervention （PCI） in patients with acute ST segment elevation myocardial infarction （STEMI）. Methods Ninety-four patients with NRP during primary PCI （within 12 hours after onset） for STEMI were randomly divided into two groups： atorvastatin group （n=54） and control group （n=40）.The two groups were both administered clopidogrel 300 mg and aspirin enteric-coated tablet 300 mg at drought before primary PCI.On this basis, the atorvastatin group was administered an additional dose of atorvastatin calcium 80 mg orally.Tirofiban 10 μg·kg-1 was injected into the coronary through a guiding catheter for 5 min when NRP occurred during PCI for the two groups.Thrombolysis in myocardial infarction（TIMI） flow grade（TIMI grade 0,TIMI grade 1-2,and TIMI grade 3）,TIMI myocardial perfusion grade （TMPG grade 0, TMPG grade 1-2, and TMPG grade 3）, corrected TIMI frame count （cTFC）and ST-segment resolution（STR）were assessed before NRP（D0） and the end of PCI（D1）.In addition, troponin I （TnI） concentrations were measured before and 12, 24 and 48 hours after PCI. Results ①There were no significant differences in TIMI grade 0 at D0 and D1, TIMI grade 1-2, TIMI grade 3 and TMPG grade 3 at D0 and TMPG grade 1-2 at D1 between the two groups （P〉0.05）. However, differences in TIMI grade 1-2, TIMI grade 3, TMPG grade 0, TMPG grade 1-2 and TMPG grade 3 were significant between D0 and D1 in both groups （P〈0.05）. Compared with control group, atorvastatin treatment significantly decreased TIMI grade 1-2 at D1 and TMPG grade 0 at D0 and D1, but obviously increased TIMI grade 3 and TMPG grade 3 at D1 and TMPG grade 1-2 at D0 （P〈0.05）.The concentrations of cTnI significantly decreased 12, 24 and 48 hours after PCI in both groups （P〈0.05）.Compared with control group, the