阿托伐他汀在减少缺血性脑卒中患者呼吸机相关性肺炎发病率的应用价值研究  

Value of Atorvastatin for Decreasing the Incidence of Ventilator-associated Pneumonia in Patients with Ischemic Stroke

作　　者：余跃天[1] 刘春艳[2] 朱昊平 毛恩强[1] 陈尔真[1] 

机构地区：[1]上海交通大学医学院附属瑞金医院急诊重症监护室,上海200025 [2]上海瑞金医院集团闵行医院重症监护室,上海201199

出　　处：《医学临床研究》2013年第3期473-476,共4页Journal of Clinical Research

基　　金：上海市卫生局青年基金（20114Y119）;上海市闵行区科委基金（2012MHZ045）

摘　　要：【目的】研究阿托伐他汀的使用是否可以减少缺血性脑卒中患者呼吸机相关性肺炎（VAP）的发生率及是否对其病程中细胞炎性因子演变存在影响。【方法】5年内共纳入缺血性脑卒中需要机械通气患者112例，依照是否在发病前服用过阿托伐他汀，分为先前服药组及对照组。比较两组患者30d内VAP的发生率及多重耐药菌感染的发生率，并比较两组患者30d内白细胞、c反应蛋白、降钙素原、肿瘤坏死因子Gt等细胞炎性因子的演变趋势。【结果】30d内先前服药组患者VAP的发生率明显低于对照组（20．7％VS40．6％，P=0．015，RR=0．486，95％C10．269～0．878）。两组患者多重耐药菌感染的发生率无明显差异（P=0．706）。两组患者30d内白细胞（P=0．301）、C反应蛋白（P=0．679）、降钙素原（P=0．990）的演变无明显统计学差异，先前服药组的患者肿瘤坏死因子α的水平明显低于对照组（P=0．002）。【结论】患者入院前长期服用阿托伐他汀对降低其缺血性脑卒中行机械通气30d内VAP的发生率有积极意义。[Objective] To explore whether the use of atorvastatin can reduce the incidence of ventilator-as- sociated pneumonia in patients with ischemic stroke and whether it has effect on the evolution of inflammatory factors or cytokines during the course of disease. [Methods] Totally 112 patients with ischemic stroke who needed mechanical ventilation were enrolled in the study. According to whether taking atorvastatin before fall- ing ill, all patients were divided into pre-medication group and control group. The incidence of ventilator-asso- ciated pneumonia and multidrug-resistant bacteria infection within 30 days were compared between two groups. The variable trends of cytokines and inflammatory factors such as leukocyte, c reactive protein（CRP）, calcito- nin（PCT） and tumor necrosis factor-alpha（TNF-α） within 30 days were also compared between two groups. [Results] The incidence of ventilator associated pneumonia in pre-medication group within 30 days was obvi- ously lower than that in control group（20.7% vs 40.6%, P =0. 015,RR=0. 486, 95% CI 0. 269-0. 878）. There was no significant difference in the incidence of multidrug-resistant bacteria infection between two groups（ P =0. 706）. There was no significant difference in the variable trends of leukocyte（ P =0. 301）, CRP （ P =0. 679） and PCT（0. 990） between the two groups. TNF-α in premedication group was obviously lower than that in control group（ P = 0. 002）. [Conclusion] The incidence of ventilator-associated pneumonia and TNF-α within 30 days in patients with ischemic stroke and mechanical ventilation who take atorvastatin before admission for long time are obviously lower those in control group.

关 键 词：卒中 并发症 肺炎 呼吸机相关性 药物疗法 

分 类 号：R743.3[医药卫生—神经病学与精神病学]