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目的探析急性心肌梗死患者急诊经皮冠状动脉介入术(PCI)术前高负荷阿托伐他汀对术中无复流的预防及对心功能的保护作用。方法前瞻性选取2013年1月至2015年1月心内科收治的120例行急诊PCI术治疗的急性心肌梗死患者,采用投掷硬币法将其分为2组,每组各60例。对照组术前给予常规治疗,研究组术前在常规治疗基础上加用80 mg阿托伐他汀顿服。对比两组患者术中TIMI血流分级、TIMI心肌灌注分级(TMPG)情况以及手术前后N末端B型利钠肽前体(NT-pro BNP)和心脏超声各项指标水平变化情况。结果两组手术成功率均为100.00%。研究组无复流发生率明显低于对照组(15.00%vs 31.67%,P<0.05),TIMI血流分级Ⅲ级所占比例明显高于对照组(85.00%vs 68.33%,P<0.05),TMPG3级的比例明显高于对照组(73.33%vs 46.67%,P<0.05)。两组患者PCI术后1 d NT-pro BNP水平均较术前明显升高(P均<0.01),随后NT-pro BNP水平逐渐下降,研究组术后各时点下降程度均较对照组更明显(P均<0.05)。两组患者术后随时间推移左室射血分数(LVEF)水平递升,左室舒张末容积指数(LVEDVI)、左室收缩末容积指数(LVESVI)、室壁运动积分指数(WMSI)水平递降,至12月时与术后1周比较差异均有统计学意义(P均<0.05);且研究组各时点LVEF较对照组有所提高,LVEDVI、LVESVI、WMSI水平不同程度地低于对照组,至12月时差异均有统计学意义(P均<0.05)。结论急性心肌梗死直接PCI术前高负荷他汀类药物可有效改善缺血心肌的再灌注,预防术中无复流,改善心功能。
Objective To investigate the prevention and treatment of no-reflow intraoperative high-load atorvastatin before acute percutaneous coronary intervention (PCI) in patients with acute myocardial infarction. Methods A total of 120 acute myocardial infarction patients undergoing emergency PCI underwent cardiac surgery from January 2013 to January 2015 in our hospital. The patients were divided into two groups according to the coin-throwing method, 60 cases in each group. The control group was given conventional treatment before surgery, and the study group was given 80 mg atorvastatin on preoperative basis. TIMI flow classification, TIMI myocardial perfusion grading (TMPG) and changes of N-terminal pro-brain natriuretic peptide (NT-pro BNP) and cardiac ultrasound before and after surgery were compared between the two groups. Results The success rate of operation in both groups was 100.00%. The incidence of no-reflow in the study group was significantly lower than that in the control group (15.00% vs 31.67%, P <0.05). The TIMI grade III grade was significantly higher than that in the control group (85.00% vs 68.33%, P <0.05) TMPG3 level was significantly higher than the control group (73.33% vs 46.67%, P <0.05). The levels of NT-pro BNP in both groups were significantly higher than preoperative one day after PCI (all P <0.01), and then the level of NT-pro BNP gradually decreased. The degree of decline in study group at each time point was more than that in control group Obviously (all P <0.05). Over time, LVEF, LVEDVI, LVESVI and WMSI decreased gradually in both groups, (P <0.05). Compared with the control group, the LVEF of the study group was higher than that of the control group, while the levels of LVEDVI, LVESVI and WMSI were lower than those of the control group , And there was significant difference between December and December (all P <0.05). Conclusion Acute myocardial infarction (PCI) with high load of statins before PCI can effectively improve the reperfusion of ischemic myocardium, prevent no-reflow during operation and improve cardiac function.