Schouten Olaf, Kok Niels F M, Boersma Eric, Bax Jeroen J, Feringa Harm H H, Vidakovic Radosav, Statius van Eps Randolph G, van Sambeek Marc R H M, Poldermans Don
Department of Vascular Surgery, Erasmus Medical Center, Rotterdam, The Netherlands.
Am J Cardiol. 2006 May 1;97(9):1383-5. doi: 10.1016/j.amjcard.2005.11.063. Epub 2006 Mar 20.
Ischemic reperfusion injury is an important cause of renal dysfunction after major vascular surgery and increases postoperative morbidity and mortality. The aim of the present study was to assess the effect of statins on renal function in patients at high risk for renal dysfunction, that is, those who underwent suprarenal aortic cross clamping-declamping. Seventy-seven patients (28 statin users, 57 men; mean age 69 +/- 8 years) with normal preoperative renal function requiring suprarenal aortic cross clamping-declamping during vascular surgery from 1995 to 2005 were studied. Creatinine levels were obtained before surgery and on days 1, 2, 3, 7, and 30 after surgery. An analysis-of-variance model for repeated measurements was applied to compare creatinine levels between statin users and nonusers, with adjustment for clamping time and blood loss. There were no differences in baseline clinical characteristics, preoperative creatinine levels (0.93 vs 0.96 mg/dl, p = 0.59), and glomerular filtration rate (79 vs 73 ml/min, p = 0.1). Postoperative creatinine levels during the 30 days after surgery were significantly lower in statin users than in nonusers (analysis-of-variance p <0.01, 1.17 vs 1.98 mg/dl). Postoperative hemodialysis was required (temporarily) in 7 patients (9.1%), all statin nonusers. These findings suggest an association between statin use and preserved renal function after suprarenal aortic clamping.
缺血再灌注损伤是大血管手术后肾功能障碍的重要原因，会增加术后发病率和死亡率。本研究的目的是评估他汀类药物对肾功能不全高危患者（即接受肾上主动脉交叉钳夹-松开术的患者）肾功能的影响。对1995年至2005年期间77例（28例他汀类药物使用者，57例男性；平均年龄69±8岁）术前肾功能正常、在血管手术中需要进行肾上主动脉交叉钳夹-松开术的患者进行了研究。在手术前以及术后第1、2、3、7和30天获取肌酐水平。应用重复测量的方差分析模型比较他汀类药物使用者和非使用者之间的肌酐水平，并对钳夹时间和失血量进行校正。基线临床特征、术前肌酐水平（0.93 vs 0.96 mg/dl，p = 0.59）和肾小球滤过率（79 vs 73 ml/min，p = 0.1）方面无差异。他汀类药物使用者术后30天内的肌酐水平显著低于非使用者（方差分析p<0.01，1.17 vs 1.98 mg/dl）。7例患者（9.1%）需要（临时）进行术后血液透析，均为非他汀类药物使用者。这些发现提示他汀类药物的使用与肾上主动脉钳夹术后肾功能的保留之间存在关联。
