北京大学学报(医学版) ›› 2014, Vol. 46 ›› Issue (4): 601-605.

• 论著 • 上一篇    下一篇

强化调脂对行非心脏手术的冠状动脉粥样硬化性心脏病患者的心肌保护作用及机制初探

夏经钢1*,曲杨2*, 胡少东1,许骥1,尹春琳1,徐东1△   

  1. (1. 首都医科大学宣武医院心脏科,北京100053;2. 首都医科大学附属北京胸科医院病理科,北京101149)
  • 出版日期:2014-08-18 发布日期:2014-08-18

Cardioprotective effect and mechanism of intensive lipid modulation on patients with coronary artery disease undergoing noncardiac surgery

XIA Jing-gang1*, QU Yang2*,HU Shao-dong1, XU Ji1, YIN Chun-lin1, XU Dong1△   

  1. (1. Department of Cardiology, Xuanwu Hospital, Capital Medical University, Beijing 100053, China; 2. Deparment of Pathology, Beijing Chest Hospital, Capital Medical University, Beijing 101149, China)
  • Online:2014-08-18 Published:2014-08-18

摘要: 目的:探讨强化阿托伐他汀治疗对稳定型冠状动脉粥样硬化性心脏病(冠心病)患者行非心脏的择期外科手术围手术期的心肌保护作用及可能机制。方法:将拟行非心脏外科手术的60名稳定型冠心病患者随机分为强化组(n=30)和常规组(n=30),强化组在术前12 h给予阿托伐他汀80 mg顿服,术前2 h给予阿托伐他汀40 mg顿服,术前每晚服用阿托伐他汀40 mg;常规组术前每晚服用阿托伐他汀20 mg;而后进行非心脏的外科手术,术后强化组每晚服用阿托伐他汀40 mg,常规组每晚服用阿托伐他汀20 mg。比较两组围手术期主要不良心脏事件(包括心脏性猝死、急性心肌梗死、非计划性血运重建)的发生情况,术前、术后48 h血脂水平(总胆固醇和低密度脂蛋白胆固醇)及炎症指标水平(高敏C反应蛋白和白细胞介素-6)的变化情况。结果:常规组出现1例急性前壁ST段抬高型心肌梗死(行急诊前降支介入再灌注治疗)和7例无症状型心肌梗死,强化组出现1例无症状型心肌梗死,强化组围手术期心肌梗死发生率较常规组明显降低(P<0.05);两组术前和术后血脂水平变化差异无统计学意义(P>0.05);与常规组相比,强化组的炎症指标水平显著降低(P<0.05)。结论:强化组可显著降低稳定型冠心病患者非心脏的择期外科手术围手术期主要不良心脏事件,特别是无症状型心肌梗死的发生率,抑制炎症反应可能是其保护作用的机制之一,但尚需大样本多中心随机对照临床试验进一步证实。

关键词: 阿托伐他汀, 冠心病, 外科手术, 猝死, 心脏, 心肌梗死

Abstract: Objective:To explore the protective effect and possible mechanism of intensive lipid modulation on the perioperative period of patients with stable coronary artery disease undergoing noncardiac surgery. Methods: In the study, 60 patients with stable coronary artery disease undergoing elective noncardiac surgery were randomly divided into intensive lipid modulation group (n=30) and conventional group (n=30). In intensive lipid modulation group, the patients were given atorvastatin 40 mg every night before surgery, 80 mg 12 h before surgery, and 40 mg 2 h before surgery, and 40 mg every night after noncardiac surgery. In conventional group, the patients were given atorvastatin 20 mg every night before surgery and also after the surgery. The occurrence of perioperative major adverse cardiac events (including sudden cardiac death, acute myocardial infarction, unplanned revascularization) were compared in the two groups. Preoperative and 48 h postoperative changes of lipid levels and inflammatory markers were also compared in the two groups. Results: In conventional group, one patient suffered myocardial infarction with acute anterior ST-segment elevation and was given emergency left anterior descending artery interventional reperfusion therapy, and 7 patients suffered asymptomatic myocardial infarction. In intensive lipid modulation group, one patient suffered asymptomatic myocardial infarction, and the incidence rate of perioperative acute myocardial infarction reduced significantly compared with conventional group (P<0.05). There was no significant difference in preoperative and postoperative changes of lipid levels in the two groups (P>0.05), and compared with conventional group, there was significantly lower levels of inflammatory markers in intensive lipid modulation group (P<0.05). Conclusion:The intensive lipid modulation group significantly reduced the incidence of perioperative major adverse cardiac events especially asymptomatic myocardial infarction, and the inhibition of the inflammatory response may be one of the protective mechanisms, which still needs to be further confirmed by large multicenter randomized controlled clinical trials.

Key words: Atorvastatin, Coronary disease, Surgical procedures, operative, Death, sudden, cardiac, Myocardial infarction

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