CAJ | 학술논문

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。
목적：탐토술전복용대제량아탁벌타정연합관상동맥내주사체라비반치료대급성 ST단태고형심기경사（STEMI）환자직접PCI 술중무복류현상（NRP）적영향。방법장94례발병12 h내행직접PCI 술중출현NRP적STEMI환자안조수궤쌍맹법분위2조：아탁벌타정조（54례）화대조조（40례）。2조행직접PCI술전균채용록필격뢰편300 mg、배아사필림장용편300 mg돈복。재차기출상，아탁벌타정조가용아탁벌타정개80 mg구복。2조술중출현NRP시，경지인도관관상동맥내주입체라비반10μg·kg-1，5 min주사완필。관찰2조환자PCI술중출현NRP전（D0）、PCI술결속전말차（D1）적심기경사용전치료（TIMI）혈류분급（TIMI 0급、1-2급、3급），TIMI심기관주분급（TMPG 0급、1-2급화3급），교정TIMI 정수（cTFC）、ST 단회락폭도（STR）급술전，술후12、24화48 h혈청심기기개단백 I （cTnI）수평적정황。결과2조D0、D1시TIMI 0급，D0시TIMI 1-2급、TIMI 3급、TMPG 3급，D1시TMPG 1-2급비례비교차이균무통계학의의（균P＞0.05）；2조D1시TIMI 1-2급、TIMI 3급、TMPG 0급、TMPG 1-2급、TMPG 3급여D0시비교차이유통계학의의（균P＜0.05）；아탁벌타정조D1시TIMI 1-2급，D0、D1시TMPG 0급비례균저우대조조， D1시TIMI 3급、D0시TMPG 1-2급、D1시TMPG3급비례균고우대조조（균P＜0.05）。아탁벌타정조STR＜30%비례저우대조조（P＜0.05）；2조술후12、24화48 h cTnI수평균명현저우술전，아탁벌타정조균명현저우대조조（균P＜0.05）。결론 PCI술전예선사용대제량아탁벌타정미능감소술중NRP적발생。술전예선사용대제량아탁벌타정가이개선NRP 출현후심기관주，연합관상동맥내주사체라비반교단순관상동맥내주사체라비반재개선NRP방면경명현。
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 percentage of patients with STR<30% and the concentrations of cTnI significantly decreased in atorvastatin group (P<0.05). Conclusion Preoperative administration of high-dose atorvastatin fails to reduce NRP during PCI but improves myocardial perfusion after the occurrence of NRP. The combination of high-dose atorvastatin administration and intracoronary tirofiban injection is more effective than tirofiban injection alone for improving NRP.