手术后间断使用或持续长期使用斯达汀对大血管手术患者心脏转归的影响  

作　　者：Yannick Le Manach Gilles Godet Pierre Coriat Claire Martinon Michèle Bertrand Marie-Hélène Fléron Bruno Riou 康茵(译) 王庆(译) 赵国栋(校) 

机构地区：[1]Departments of Anesthesiology and Critical Care [2]Emergency Medicine and Surgery, Centre Hospitalier Universitaire Pitié-Salpētrière,Assistance-Publique H6pitaux de Paris, Universit6 Pierre et Marie Curie-Paris 6, Paris, France [3]不详

出　　处：《麻醉与镇痛》2008年第4期7-14,共8页Anesthesia & Analgesia

摘　　要：背景斯达汀可降低非手术人群的心脏并发症，手术患者也可能受益。本研究旨在观察与间断使用者比较，大血管手术后持续使用斯达汀患者的心脏转归有无差异。方法对前瞻性收集的肾下型主动脉手术患者的资料进行研究，分析斯达汀治疗和围手术期心脏并发症的相关性。2001年1月至2003年12月，临床尚无围手术期持续使用斯达汀的指南（间断使用组，n=491）。2004年1月制定指南推荐手术后尽早开始斯达汀持续治疗（持续使用组，n=178）。分析心肌坏死（定义为肌钙蛋白Ⅰ增高〉99百分位数或0．2ng/ml）的发生情况。组内（倾向性评分）和组间（Lee评分）均进行风险调整。结果 间断使用组和持续使用组手术后重新使用斯达汀治疗的时间间隔中位数分别为4天和1天（P〈0．001）。采用倾向性评分对手术前斯达汀治疗的可能性进行匹配，结果显示，手术后早期使用斯达汀和未早期使用（持续使用组与间断使用组）对手术后心肌坏死风险的比值比（OR）分别为0．38和2．1（相对危险度降低5．4倍，95％可信区间：1．2—25．3，P〈0．001）。经Lee评分调整后OR在持续使用组为0．38，间断使用组为2．1（相对危险度降低5．5倍，95％可信区间：1．2～26．0，P〈0．001）。手术后斯达汀停药（〉4天）是手术后心肌坏死的独立预测因素（OR2．9，95％可信区间：1．6—5．5）。结论大血管手术后间断使用斯达汀与手术后心脏风险增高相关，建议大血管手术后尽早使用斯达汀。BACKGROUND： Statins reduce cardiac morbidity in nonsurgical populations, and may benefit surgical patients. We sought to examine cardiac outcome in patients who continued, compared with those who discontinued, statin therapy after major vascular surgery. METHODS： Prospectively collected data were examined for an association between statin therapy and perioperative cardiac morbidity in patients undergoing infrarenal aortic surgery. Between January 2001 and December 2003, there were no guidelines for perioperative continuation of statins （discontinuation group, n = 491 ）. From January 2004, guidelines were instituted whereby statin therapy was continued starting as soon as possible after surgery （continuation group, n = 178）. The occurrence of cardiac myonecrosis （defined as an increase of cardiac troponin I more than the 99th percentile or 0. 2 ng/ml） was analyzed. Intra-cohort （propensity score） and extra-cohort （Lee score） adjustments of the risk were performed. RESULTS： The median delay between surgery and resumption of statin therapy was 4 days and 1 day in the discontinuation and continuation groups （P 〈 0. 001 ）, respectively. Using propensity score matching for likelihood of preoperative treatment, the odds ratio associated with chronic statin treatment to predict myonecrosis for patients with versus without early postoperative statin resumption （continuation versus discontinuation groups） was 0.38 and 2.1 （relative risk reduction of 5.4, 95 % confidence interval： 1. 2 - 25.3, P 〈 0. 001 ）, respectively. The odds ratio after adjustment for the Lee score was 0.38 in the continuation group and 2. 1 in the discontinuation group （relative reduction of 5.5; 95% confidence interval： 1.2 -26.0, P 〈 0.001 ）. Postoperative statin withdrawal （ 〉 4 days） was an independent predictor of postoperative myonecrosis （OR 2.9, 95% confidence interval 1.6 -5.5）. CONCLUSIONS： Discontinuation of statin therapy after major vascular surgery is associated with an incr

关 键 词：大血管手术 心脏并发症 手术后 转归 相对危险度降低 持续使用 持续治疗 心肌坏死 

分 类 号：R654.3[医药卫生—外科学] R544.1[医药卫生—临床医学]