围术期口服辛伐他汀减轻体外循环后全身炎症反应的随机对照研究

Efficacy of perioperative simvastatin on systemic inflammatory response after cardiac valve surgery with cardiopulmonary bypass: a randomized control trial

目的探讨围手术期口服辛伐他汀减轻体外循环心脏瓣膜手术后患者全身炎症反应的作用。方法将130名体外循环下行心脏瓣膜手术的患者随机分成两组,试验组:65例,围手术期口服辛伐他汀片20 mg/晚;对照组:65例,口服同剂量安慰剂。记录患者术前临床基线情况和术后辅助呼吸时间、24小时尿量与引流量、ICU停留时间和术后10天左室射血分数等;在主动脉阻断前、主动脉开放后不同时间点抽血测定患者血清肌钙蛋白T(c Tn T)、肌酸激酶同工酶(CKMB)、肿瘤坏死因子(TNF-α)、白细胞介素6(IL-6)、白细胞介素8(IL-8)、C反应蛋白(CRP)、血清尿素氮(BUN)和血清肌酐(Cr)。结果围手术期口服辛伐他汀可明显降低辅助呼吸时间(9.92±3.42 h VS 11.69±4.79 h,P=0.03)和改善术后左室射血分数(58.91%±8.48%VS55.50%±7.04%,P=0.024),但对于术后24 h尿量、引流量和ICU停留时间的影响,差异无统计学意义;服用辛伐他汀相对于对照组可降低血浆c Tn T、CKMB、TNF-α、IL-6、IL-8、CRP、BUN和Cr的水平,差异有统计学意义(P<0.05)。结论围手术期口服辛伐他汀可以减轻体外循环手术引起的全身炎症反应并减轻心脏、肾脏等器官损伤,改善患者预后。

Objective To investigate the effect of simvastatin against systemic inflammatory response and organ damage in cardiac valve surgery with cardiopulmonary bypass（CPB）. Methods130 patients who underwent cardiac valve surgery with CPB were randomly assigned to either a stain group（n =65） or a control group（n =65）. Simvastain（20 mg） was administered preoperatively and postoperatively. The ICU detention time, time of using assisted ventilation, amount of urine, drainage in 24 hours after operation and left ventricular ejection fraction at 10 days postoperation were recorded.Plasma and left ventricular ejection fraction at 10 days postoperation were analyzed for troponin T（c Tn T）, isoenzyme of creatine kinase（CKMB）, tumor necrosis factor alpha（TNF-α）, interleukin-6（IL-6）, interleukin-8（IL-8）, C-reactionprotein（CRP）, blood urea nitrogen（BUN） and Creatinine（Cr）. Results Simvastatin significantly reduced the time of using assisted ventilation ejection fraction was higher in the statin group than in the control group at 10 das postoperation（P〈0.05）, but there were no significant difference in ICU detention time, amount of urine and drainage in 24 hours after operation between the two groups（P〉0.05）. Simvastatin significantly reduced the lever of c Tn T, CKMB,TNF-α, IL-6, IL-8, CRP, BUN, Cr（P〈0.05）. Conclusion Perioperative stain therapy can reduce the system inflammatory response and organ damage after CPB and improve the prognosis of patients.