阿托伐他汀对脓毒性休克患者的心肺保护作用  

Cardiopulmonary protective effect of atorvastatin in patients with septic shock

作　　者：陈如杰[1] 郭献阳[1] 程碧环[1] 龚裕强[1] 应斌宇[1] 

机构地区：[1]温州医科大学附属第二医院重症医学科,浙江温州325027

出　　处：《中华危重症医学杂志（电子版）》2015年第5期291-295,共5页Chinese Journal of Critical Care Medicine:Electronic Edition

基　　金：温州市科技局科研基金资助项目(Y20140256)

摘　　要：目的探讨阿托伐他汀对脓毒性休克患者心肺的保护作用。方法将60例脓毒性休克患者分成治疗组及对照组,每组各30例,均按脓毒性休克指南行集束化治疗,治疗组加用阿托伐他汀20 mg/d,分别检测两组患者治疗前和治疗后7、10 d血清肌酸激酶同工酶(CK-MB)、肌钙蛋白(c Tn I)、脑钠肽(BNP),肿瘤坏死因子α(TNF-α)、C反应蛋白(CRP)、血清降钙素原(PCT)、动脉血氧分压(Pa O2)、二氧化碳分压(PCO2)及氧合指数。同时记录治疗前后急性病生理学和长期健康评价(APACHE)Ⅱ评分和Marshall评分。结果两组患者治疗前后CK-MB、CRP、Pa O2及PCO2比较,差异均无统计学意义(F=1.599、1.109、0.709、1.931,P均>0.05)。而两组患者c Tn I、BNP、TNF-α、PCT、氧合指数、APACHEⅡ评分及Marshall评分治疗前后的比较,差异均有统计学意义(F=32.334、13.199、8.346、6.903、5.076、5.235、4.836,P均<0.05),进一步比较发现,在治疗后7、10 d治疗组c Tn I[(2.5±1.1)μg/L vs.(3.4±1.5)μg/L;(1.1±0.3)μg/L vs.(1.8±0.6)μg/L]、BNP[(3 156±576)ng/L vs.(3 625±763)ng/L;(2 395±634)ng/L vs.(2 986±854)ng/L]、TNF-α[(143±42)ng/L vs.(172±56)ng/L;(93±32)ng/L vs.(121±42)ng/L]及PCT[(6.5±2.4)μg/L vs.(7.9±2.2)μg/L;(3.3±1.2)μg/L vs.(4.9±1.9)μg/L]均显著低于对照组(P均<0.05)。而治疗组氧合指数[(257±56)mm Hg vs.(224±39)mm Hg]、APACHEⅡ评分[(13±4)分vs.(16±5)分]及Marshall评分[(5.4±1.9)分vs.(6.9±2.3)分]仅在治疗后10 d与对照组比较差异均有统计学意义(P均<0.05)。结论阿托伐他汀可减少脓毒性休克患者机体炎症反应,对心肺有保护作用。Objective To explore the cardiopulmonary protective effect of atorvastatin in patients with septic shock. Methods A total of 60 patients with septic shock were randomized into two groups： atorvastatin treatment group （n = 30） and control group （n = 30）. Every patient received sepsis bundle therapy according to the 2012 International Sepsis Guidelines. The levels of creatine kinase isoenzyme （CK-MB）, cardiac troponin I （cTnI）, brain natriuretic peptide （BNP）, tumor necrosis factor-alpha （TNF-α）, C-reactive protein （CRP）, procalcitonin （PCT）, partial pressure of oxygen （PaO2）, arterial partial pressure of CO2 （PCO2） and oxygenation index were measured respectively, and acute physiology and chronic health evaluation, APACHEⅡ score and Marshall score were recorded before treatment and on 7, 10 d after treatment. Results The levels of CK-MB, CRP, PaO2 and PCO2 before and after treatment all showed no significant differences between the two groups （F= 1.599, 1.109, 0.709, 1.931, all P〉0.05）. The levels ofcTnI, BNP, TNF-c~, PCT, oxygenation index, APACHE Ⅱ score and Marshall score in the two groups were significantly different before and after treatment （F= 32.334, 13.199, 8.346, 6.903, 5.076, 5.235, 4.836, all P 〈 0.05）. Furthermore, on 7, 10 d after the treatment, the levels of cTnI [（2.5 ± 1.1） μg / L vs. （3.4 ± 1.5） μg / L; （1.1 ± 0.3）μg / L vs. （1.8 ± 0.6） μg / L], BNP [（3 156 ± 576） ng / L vs. （3 625 ± 763） ng / L; （2 395 ± 634） ng / L vs. （2 986 ± 854） ng / L], TNF-α [（143 ± 42） ng / L vs. （172 ± 56） ng / L; （93 ± 32） ng / L vs. （121 ± 42） ng / L], PCT [（6.5 ± 2.4） μg / L vs. （7.9 ± 2.2）μg / L; （3.3 ± 1.2） μg / L vs. （4.9 ± 1.9） μg / L] in the atorvastatin treatment group were much lower than those in the control group, and the oxygenation index in the atorvastatin treatment group were higher, the APACHE II score and Marshall score were lower than those in the control

关 键 词：阿托伐他汀 休克 脓毒性 心肺保护 

分 类 号：R459.7[医药卫生—急诊医学]