术前他汀类药物治疗对冠状动脉旁路移植术后胸骨切口感染事件和主要心脑血管不良事件发生的影响  

Effect of preoperative statin therapy on the incidence of sternum incision infection and major cardiovascular and cerebrovascular adverse events after coronary artery bypass grafting

作　　者：王家阳[1] 张魁[1] 董然[1] 王健 Wang Jiayang;Zhang Kui;Dong Ran;Wang Jian(Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China;Director Office, Fifth Hospital in Harbin, 150040 Harbin, China)

机构地区：[1]首都医科大学附属北京安贞医院心脏外科,100029 [2]哈尔滨市第五医院院长办公室,150040

出　　处：《中华损伤与修复杂志（电子版）》2020年第2期128-132,共5页Chinese Journal of Injury Repair and Wound Healing(Electronic Edition)

基　　金：国家自然科学基金青年项目(81900098)。

摘　　要：目的探讨冠状动脉旁路移植术(CABG)术前应用他汀类药物干预对患者术后胸骨切口感染事件发生率和主要心脑血管不良事件发生情况的影响。方法选择2019年1月至12月于首都医科大学附属北京安贞医院心外科住院并行CABG治疗的患者880例。503例(57.2%)患者在CABG术前接受过他汀类药物治疗,将这些患者设为试验组;其余377例患者术前未应用他汀类药物,设为对照组。比较试验组和对照组患者的胸骨切口感染事件和主要心脑血管不良事件发生情况,再进行相应的风险因素分析。数据比较采用χ2检验、单因素方差分析和多元逻辑回归分析。结果试验组患者CABG术后胸骨切口感染事件的发生率、主要心脑血管不良事件的发生率分别为2.0%、27.6%,与对照组(5.6%、35.0%)比较,差异均有统计学意义(χ2=0.869、0.298,P=0.005、0.022)。同时多元逻辑回归结果显示患者CABG术前应用他汀类药物治疗与术后胸骨切口感染事件显著下降具有独立相关性(OR 0.34,95%CI 0.16~0.74,P=0.006)。此外,术前应用他汀类药物干预也与CABG术后主要心脑血管不良事件的发生率降低独立有关(OR 0.60,95%CI 0.44~0.81,P=0.001)。结论术前应用他汀类药物治疗能够降低患者CABG术后胸骨切口感染事件和主要心脑血管不良事件的发生。Objective To investigate the independent relationship between preoperative statin therapy and postoperative sternal wound infection major cardiovascular and cerebrovascular adverse events in patients undergoing coronary artery bypass grafting(CABG).Methods A toal of 880 patients undergoing CABG were enrolled from January 1,2019 to December 31,2019 in Beijing Anzhen Hospital,Capital Medical University.Five hundred and three patients(57.2%)who received statins before CABG were assigned to the experimental group.The remaining 377 patients were not treated with statins before surgery and were set as the control group.The incidence of sternal incision infection and major cardiovascular and cerebrovascular adverse events in the experimental group and the control group were compared,and the corresponding risk factors were analyzed.Data were compared with chi-square test,single factor analysis of variance and multivariate logistic regression analysis.Results The incidence of sternal incision infection and the incidence of major cardiovascular and cerebrovascular adverse events were 2.0%and 27.6%,respectively,compared with the experimental group(5.6%and 35.0%),the differences were statistically significant(χ2=0.869,0.298;P=0.005,0.022).Specifically,preoperative statin therapy independently reduced the incidence of sternal wound infection after CABG(OR 0.34,95%CI 0.16-0.74;P=0.006)and major cardiovascular and cerebrovascular adverse events(OR 0.60,95%CI 0.44-0.91;P=0.001).Conclusion Preoperative statin therapy is effective in deep sternal wound infection and major cardiovascular events among high-risk patients undergoing CABG.

关 键 词：冠状动脉旁路移植术 非体外循环 胸骨切开术 感染 主要心脑血管不良事件 

分 类 号：R65[医药卫生—外科学]