非体外循环冠状动脉旁路移植术术前单次他汀强化负荷减轻术后心肌损伤的随机对照试验  

Single High-dose Atorvastatin Loading before Off-pump Coronary Artery Bypass Grafting Alleviates Postoperative Myocardial Injury:A Prospective Randomized Controlled Trial

作　　者：张杨杨[1,2] 魏磊[1,2] 夏宇[3] 王晓伟[1,2] 徐骁晗[1,2] 张蔚然[1,2] 陈亦江[1,2] 

机构地区：[1]江苏省人民医院 [2]南京医科大学第一附属医院心胸外科,南京210029 [3]上海交通大学附属新华医院心胸外科,上海200092

出　　处：《中国胸心血管外科临床杂志》2014年第6期713-720,共8页Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

基　　金：国家自然科学基金资助项目(81170158)~~

摘　　要：目的探讨非体外循环冠状动脉旁路移植术(OPCAB)术前单次他汀强化负荷的安全性及其对术后心肌保护的作用。方法纳入江苏省人民医院2010年2月至2011年8月期间140例择期行OPCAB的患者,于术前12 h用统计软件产生随机序列,将患者分为对照组和单次负荷80 mg阿托伐他汀的他汀负荷组,每组70例。检测入院时、术后6 h、术后12 h、术后24 h、术后48 h、术后72 h、术后96 h和术后120 h 8个时间点心肌损伤标志物[肌钙蛋白T(Tn T)、心肌型肌酸激酶同工酶(CK-MB)、肌红蛋白(Mb)],以及术前2 d、术后1 d、术后4 d、术后7 d和出院前等5个时间点的肝脏功能[谷丙转氨酶(ALT)、谷草转氨酶(AST)和总胆红素(TBIL)]、血脂[总胆固醇(TC)、甘油三酯(TG)和低密度脂蛋白胆固醇(LDL-C)]以及超敏C反应蛋白(hs CRP)。结果所有患者均手术顺利,康复出院。两组患者术前临床资料及上述指标差异无统计学意义(P>0.05)。围手术期两组ALT和AST水平差异无统计学意义,且术后ALT(4.29%vs.5.71%,P=1.000)和AST(4.29%vs.0%,P=0.245)大于3倍正常值上限的发生率差异无统计学意义。与对照组比较,他汀负荷组术后Tn T[(0.23±0.27)ng/ml vs.(0.16±0.24)ng/ml,P=0.011]、CK-MB[(29.57±30.04)U/L vs.(17.73±14.07)U/L,P=0.001]、hs CRP[(31.85±22.89)mg/L vs.(20.81±10.96)mg/L,P=0.001)峰值显著降低。他汀负荷组Tn T大于正常值上限的发生率(47.1%vs.65.7%,P=0.041)及大于5倍正常值上限的发生率(8.6%vs.22.9%,P=0.037)均低于对照组。他汀负荷组CK-MB大于正常值上限的发生率低于对照组(20.0%vs.54.3%,P=0.000)。结论 OPCAB术前单次他汀强化负荷安全,且有减轻术后心肌损伤的作用。Objective To evaluate the safety and myocardial protective results of single high-dose Atorvastatin loading before off-pump coronary artery bypass grafting （OPCAB）. Methods A total of 140 patients undergoing selective OPCAB in Jiangsu Province Hospital between February 2010 and August 2011 were recruited in this study. All the patients were randomly divided into a control group and an Atorvastatin loading group （single oral atorvastatin 80 mg）with 70 patients in each group. Biomarkers of cardiac injury including Troponin T （TnT）, creatine kinase-MB （CK-MB） and myoglobin （Mb） were measured on admission, 6, 12, 24, 48, 72, 96 and 120 hours after OPCAB. Liver function （alanine aminotrans- ferase （ALT）, aspartate aminotransferase （AST） and total bilirubin （TBIL） ）, serum lipids （total cholesterol （ TC ）, trigl-yceride （TG） and low-density lipoprotein cholesterol （LDL-C）） and high-sensitivity C-reactive protein （hsCRP） were measured 2 days before OPCAB, 1,4 and 7 days after OPCAB as well as before discharge. Results All the patients successfully received OPCAB and were discharged. There was no statistical difference in preoperative clinical characteristics or above indexes between the 2 groups （P 〉 0.05）. There was no statistical difference in ALT or AST between the 2 groups. Incidences of ALT （4.29% vs. 5.71%, P=-1.000） and AST （4.29% vs. 0%, P=0.245 ） greater than 3 times above the upper normal limit were not statistically different between the 2 groups. Peak levels of postoperative TnT （0.23 ± 0.27 ng/ml vs. 0.16＋0.24 ng/ml,P=0.011 ）, CK-MB （29.574-30.04 U/L vs. 17.73± 14.07 U/L,P=0.001 ）and hsCRP （31.85±22.89 mg/L vs. 20.81± 10.96 mg/L, P=-0.001 ） of the control group were significantly higher than those of Atorvastatin loading group. Incidences of TnT greater than the upper normal limit （47.1% vs. 65.7%, P=0.041 ） and TnT greater than 5 times above the upper normal limit （ 8.6% vs. 22.9%, P=0.037） of Atorvastatin loadi

关 键 词：非体外循环冠状动脉旁路移植术 心肌损伤 他汀 随机对照试验 

分 类 号：R654.2[医药卫生—外科学]