CAJ | 학술논문

目的：观察不同剂量阿托伐他汀对ST段抬高型心肌梗死( STEMI)患者直接经皮冠脉介入治疗( PCI)后对心肌细胞及冠脉血流的影响。方法：选择120例急性心肌梗死(AMI)患者,随机分为40 mg阿托伐他汀组(n=60)和80 mg阿托伐他汀组(n=60)。入选者均在发病6h内行直接PCI治疗,记录冠脉病变程度、心肌梗死溶栓治疗试验(TIMI)分级；比较两组间的一般状况、冠脉造影及介入治疗结果；观察两组再灌注损伤事件的发生情况；综合评价阿托伐他汀对急性MI/RI后的保护作用及其相关机制。结果：两组间一般情况、临床生化指标、冠脉病变分布情况未见统计学差异( P﹥0．05)； PCI术后梗死相关动脉(IRA)的TIMI3级血流获得率未见统计学差异(P﹥0．05),均无无复流发生；两组直接PCI术后90 min心电图ST段回落(STR)率有统计学差异(P<0．05)； PCI术后两组均出现再灌注心律失常(RA),80 mg阿托伐他汀组RA的发生率大于40 mg阿托伐他汀组,差异有统计学意义(P<0．05)；两组均未出现严重心脏不良事件(P﹥0．05)。结论：阿托伐他汀减轻AMI患者直接PCI术后MI/RI,进而改善近期临床预后,且80 mg阿托伐他汀改善冠脉血流功能作用优于40 mg阿托伐他汀。
목적：관찰불동제량아탁벌타정대ST단태고형심기경사( STEMI)환자직접경피관맥개입치료( PCI)후대심기세포급관맥혈류적영향。방법：선택120례급성심기경사(AMI)환자,수궤분위40 mg아탁벌타정조(n=60)화80 mg아탁벌타정조(n=60)。입선자균재발병6h내행직접PCI치료,기록관맥병변정도、심기경사용전치료시험(TIMI)분급；비교량조간적일반상황、관맥조영급개입치료결과；관찰량조재관주손상사건적발생정황；종합평개아탁벌타정대급성MI/RI후적보호작용급기상관궤제。결과：량조간일반정황、림상생화지표、관맥병변분포정황미견통계학차이( P﹥0．05)； PCI술후경사상관동맥(IRA)적TIMI3급혈류획득솔미견통계학차이(P﹥0．05),균무무복류발생；량조직접PCI술후90 min심전도ST단회락(STR)솔유통계학차이(P<0．05)； PCI술후량조균출현재관주심률실상(RA),80 mg아탁벌타정조RA적발생솔대우40 mg아탁벌타정조,차이유통계학의의(P<0．05)；량조균미출현엄중심장불량사건(P﹥0．05)。결론：아탁벌타정감경AMI환자직접PCI술후MI/RI,진이개선근기림상예후,차80 mg아탁벌타정개선관맥혈류공능작용우우40 mg아탁벌타정。
OBJECTIVE: To investigate the effect of myocardial perfusion after different doses of atorvastatin on the ST-segment elevation myocardial infarction in patients treatad by direct percutaneous coronary intervention ( PCI) . METHODS: 120 patients who were diagnosed as acute myocardial infarction (AMI) were randomly divided into two groups: 40mg atorvastatin group (n=60) and 80mg atorvastatin group (n=60). The patients accepted the PCI treatment in 6 hours. The degree of coronary lesions and TIMI flow grade were recorded. The study comprehensivly evaluated the protective effect and mechanism of atorvastatin after acute MI/RI. RE-SULTS: ①There were no statistical significant difference in baseline clinical characteristics and the distribution of coronary artery le-sions between two groups (P>0. 05); ②There were no significant difference in percentage of TIMI 3 flow achieved in IRA after PCI between the two groups (P>0. 05). No-reflow didn’ t occur in both groups; ③There was statistically significant difference in ST segment within 90 minutes after PCI in the two groups (P<0. 05); ④Reperfusion arrhythmias were occurred in both groups, and the rate of reperfusion arrhythmias in 80 mg atorvastatin group was higher than that in the 40 mg atorvastatin group (P<0. 05); ⑤There were no myocardial re-infarction, target vessel revascularization, shock and death during hospitalization in two groups. CONCLU-SION: Atorvastatin can reduce cardiac myocyte apoptosis, protect mitochondrial function and relieve the ischemic reperfusion injury in patients with AMI after direct PCI.