阿托伐他汀对冠状动脉旁路移植术后心房颤动的影响  

Effect of atorvastatin on postoperative atrial fibrillation in patients undergoing coronary artery bypass grafting

作　　者：孙益峰[1] 梅运清[1] 季强[1] 王玺胜[1] 冯靖[1] 蔡建志[1] 周永新[1] 谢士梁[1] 

机构地区：[1]同济大学附属周济医院胸心外科,上海200065

出　　处：《中华医学杂志》2009年第42期2988-2991,共4页National Medical Journal of China

摘　　要：目的探讨阿托伐他汀对冠状动脉旁路移植（CABG）术后心房颤动（房颤）的影响。方法随机、对照、双盲、前瞻性研究。单纯行CABG术的患者140例，其中71例入选他汀组（术前1周服阿托伐他汀20mg／d），69例入选对照组（不给予阿托伐他汀）。使用心电监护仪对CABG患者进行术后持续心电监测至少7d，记录房颤的发生及持续时间。术前及术后24h、72h、7d检测高敏C反应蛋白（hs—CRP）水平。结果他汀组中有10例在术后7d内至少发生了1次房颤，显著低于对照组（14％vs34％，P=0．009）；他汀组首次房颤持续时间明显短于对照组[（3．6±0．4）h比（5．7±0．5）h，P〈0．01]。Logistic回归显示使用阿托伐他汀是降低术后房颤发生的独立影响因素（OR=0．219，95％C10．076～0．633）。他汀组术后hs—CRP均显著低于对照组[术后24h（23±5）g／L比（32±7）g／L，P〈0．01]；术后72h[（42±8）g／Lvs（68±6）g／L，P〈0．01]；术后7d[（11±3）g／L比（31±9）g/L，P〈0．01]。结论阿托伐他汀能抑制CABG术后炎症反应，降低术后房颤的发生率，缩短房颤的持续时间，对CABG术后房颤有防治作用。Objective To evaluate the effect of atorvastatin on postoperative atrial fibrillation （AF） in patients undergoing coronary artery bypass grafting （ CABG ）. Methods A cohort of 140 consecutive patients without a history of documented AF or previous statin use, who were scheduled to undergo selective CABG, were enrolled. Included patients were randomly assigned to atorvastatin group （ n = 71 ） who were administered atorvastatin 20 mg/d or to control group （n = 69 ）. After CABG, subjects were monitored continuously by electrocardiographic monitors at least 7 days. During the initial postoperative 7 d, the incidence and duration of AF were recorded. And the levels of high-sensitivity C-reactive protein （hs-CRP） were measured before and 24 hours, 72 hours, 7 days after operation, respectively. The statistical software package SPSS （ version 13. 0） were used to analyze the data. The differences between groups were evaluated by χ2-test for discrete variables and student t-test for continuous variables. Multivariate logistic regression analysis was performed to determine the independent predictors of early postoperative AF. Results During initia/postoperative 7 d, AF occurred at/east once in 10 eases in atorvastatin group, with a prevalence of roughly 14% , and in 23 cases in control group, with a prevalence of approximately 34% （P =0. 009）. The mean duration of single AF was 3.6 ±0.4 hours in atorvastatin group and 5.7 ±0. 5 hours in control group （P 〈 0.01 ）, respectively. The multivariate logistic analysis showed that perioperative atrovastatin administration was an independently risk factor for early postoperative AF （ OR = 0. 219, 0. 076 - 0. 633, P=0.005）. There was also statistical difference in hs-CRP after CABG between the two groups. Condusions Perioperative atrovastatin administration may inhibit inflammatory reaction, reduce the incidence and duration of postoperative AF, hence may prevent and treat postoperative AF.

关 键 词：心房颤动 冠状动脉疾病 阿托伐他汀 

分 类 号：R686[医药卫生—骨科学]