负荷量阿托伐他汀对稳定型冠心病患者非心脏手术围手术期保护作用的研究

目的:探讨负荷量阿托伐他汀对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的保护作用。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负荷量阿托伐他汀组(n=30)和对照组(n=30),其中负荷量阿托伐他汀治疗组在术前12小时给予阿托伐他汀80 mg顿服,术前2小时阿托伐他汀40 mg顿服,且每晚服用阿托伐他汀40 mg,对照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(主要病种为慢性胆囊结石胆囊炎、慢性阑尾炎、消化性溃疡、疝气),术后负荷量组给予每晚服用阿托伐他汀40 mg,对照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。结果:对照组出现1例急性前壁ST段抬高型心肌梗死并行急诊前降支介入再灌注治疗和7例无症状型心肌梗死,负荷量阿托伐他汀组出现1例无症状型心肌梗死,围手术期心肌梗死发生率较对照组明显降低(P0.05)。结论:负荷量阿托伐他汀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如心肌梗死,特别是无症状型心肌梗死的发生率,但该结果尚需大样本多中心随机对照临床试验进一步证实。

Research on the Protective Effect of Loading Dose of Atorvastatin on the Perioperative Period of Patients with Stable Coronary Artery Disease Undergo Noncardiac Surgery*

ABSTRACT Objective:To explore the protective effect of loading dose of atorvastatin on the perioperative period of patients with stable coronary artery disease undergoing noncardiac surgery. Methods:60 patients with stable coronary artery disease undergoing elective noncardiac surgery were randomly divided into the loading dose of atorvastatin group (n=30) and control group (n=30). In the loading dose of atorvastatin treatment group, patients were given atorvastatin 80 mg, 12 hours before surgery, atorvastatin 40 mg two hours before surgery, and atorvastatin 40 mg every night before surgery. In control group, patients were given atorvastatin 20 mg every night before surgery, and after noncardiac surgery (gallstone disease and chronic cholecystitis, chronic appendicitis, peptic ulcer, hernia), in the loading dose group patients were given atorvastatin 40 mg every night, in control group atorvastatin 20 mg. The occurrence of perioperative major adverse cardiac events (including sudden cardiac death, acute myocardial infarction, unplanned revascularization) were compared between the two groups.Results: In control group, 1 patient suffered myocardial infarction with acute anterior ST-segment elevation and was given emergency left anterior descending artery interventional reperfusion therapy, 7 patients suffered myocardial infarction with non-ST-segment elevation. In the loading dose of atorvastatin group, 1 patient suffered myocardial infarction with acute non-ST-segment elevation, the incidence rate of perioperative acute myocardial infarction reduced significantly compared with control group (P<0.05).Conclusion: Loading dose of atorvastatin significantly reduced the incidence of perioperative major adverse cardiac events such as myocardial infarction, especially asymptomatic myocardial infarction in patients with stable coronary artery disease undergoing elective non-cardiac surgery, but the results still need to be further confirmed by large multicenter randomized controlled clinical trials.