Williams Trevor M, Harken Alden H
Department of Surgery, University of California, San Francisco-East Bay, Oakland, CA, USA.
Ann Surg. 2008 Jan;247(1):30-7. doi: 10.1097/SLA.0b013e3181492c0d.
To evaluate perioperative statin treatment, to explore the rapidly increasing body of literature on the pleiotropic effects of statins, and to suggest a rational strategy of perioperative risk reduction.
Vascular, cerebrovascular, and cardiovascular complications are all too common in surgery. Although treatment with beta-blockers is a well-established strategy for perioperative cardiac risk reduction, prophylaxis with statins enjoys a firm pathophysiologic basis.
A PubMed search for studies evaluating outcomes of statin treatment in surgical series was accomplished by evaluating all articles found with the keyword "surgery" and the MeSH term for statins "hydroxymethylglutaryl-CoA reductase inhibitors." Studies where no outcome was relatable to statin treatment were excluded as were studies dealing primarily with transplant surgery. An overview of the medical literature on statin use and cardiac outcome was also performed. Basic science investigations elucidating the mechanisms and effects of statins that may reduce perioperative risk were included.
The pharmacology and pleiotropic effects of statins are delineated. Multiple beneficial outcomes are elucidated and explored. Statins prescribed in the perioperative period appear beneficial though only one clinical trial is available from which to make clinical recommendations.
Evidence supports a rebound effect. Statin treatment should be instituted and must not be discontinued in surgical patients. Current literature suggests that statins are protective in the preoperative period.
评估围手术期他汀类药物治疗，探讨关于他汀类药物多效性的迅速增长的文献，并提出合理的围手术期降低风险策略。
血管、脑血管和心血管并发症在手术中极为常见。虽然使用β受体阻滞剂治疗是降低围手术期心脏风险的既定策略，但他汀类药物预防有坚实的病理生理基础。
通过评估所有以关键词“手术”和他汀类药物的医学主题词“羟甲基戊二酰辅酶A还原酶抑制剂”检索到的文章，完成在手术系列中评估他汀类药物治疗结果的PubMed搜索。排除无与他汀类药物治疗相关结果的研究以及主要涉及移植手术的研究。还对关于他汀类药物使用和心脏结局的医学文献进行了综述。纳入阐明可能降低围手术期风险的他汀类药物机制和作用的基础科学研究。
阐述了他汀类药物的药理学和多效性作用。阐明并探讨了多种有益结局。围手术期使用他汀类药物似乎有益，不过仅有一项临床试验可用于做出临床推荐。
有证据支持反弹效应。手术患者应开始使用他汀类药物治疗且不得停药。当前文献表明他汀类药物在术前具有保护作用。
