术后早期他汀类药物治疗与心脏手术后急性肾损伤的发生率降低有关。
Early postoperative statin therapy is associated with a lower incidence of acute kidney injury after cardiac surgery.
机构信息
Department of Anesthesiology, Vanderbilt University, Nashville, TN, USA.
出版信息
J Cardiothorac Vasc Anesth. 2010 Dec;24(6):913-20. doi: 10.1053/j.jvca.2010.03.024.
OBJECTIVE
To test the hypothesis that perioperative statin use reduces acute kidney injury (AKI) after cardiac surgery.
DESIGN
A retrospective analysis of prospectively collected data from an ongoing clinical trial.
SETTING
A quaternary-care university hospital.
PARTICIPANTS
Three hundred twenty-four adult elective cardiac surgery patients.
INTERVENTIONS
None.
MEASUREMENTS AND MAIN RESULTS
The authors assessed the association of preoperative statin use, early postoperative statin use, and acute statin withdrawal with the incidence of AKI. Early postoperative statin use was defined as statin treatment within the first postoperative day. Statin withdrawal was defined as the discontinuation of preoperative statin treatment before surgery until at least postoperative day 2. Logistic regression and propensity score modeling were used to control for AKI risk factors. Sixty-eight of 324 patients (21.0%) developed AKI. AKI patients stayed in the hospital longer (p = 0.03) and were more likely to develop pneumonia (p = 0.002) or die (p = 0.001). A higher body mass index (p = 0.003), higher central venous pressure (p = 0.03), and statin withdrawal (27.4 v 14.7%, p = 0.046) were associated with a higher incidence of AKI, whereas early postoperative statin use was protective (12.5% v 23.8%, p = 0.03). Preoperative statin use did not affect the risk of AKI. In multivariate logistic regression, age (p = 0.03), male sex (p = 0.02), body mass index (p < 0.001), and early postoperative statin use (odds ratio = 0.32; 95% confidence interval, 0.14-0.72; p = 0.006) independently predicted AKI. Propensity score-adjusted risk assessment confirmed the association between early postoperative statin use and reduced AKI (odds ratio = 0.30; 95% confidence interval, 0.13-0.70; p = 0.005).
CONCLUSIONS
Early postoperative statin use is associated with a lower incidence of AKI among both chronic statin users and statin-naive cardiac surgery patients.
目的
检验围手术期他汀类药物使用可降低心脏手术后急性肾损伤（AKI）这一假说。
设计
对正在进行的临床试验中前瞻性收集的数据进行回顾性分析。
地点
一所四级保健大学医院。
参与者
324 例择期行心脏手术的成年患者。
干预措施
无。
测量和主要结果
作者评估了术前他汀类药物使用、术后早期他汀类药物使用和急性他汀类药物停药与 AKI 发生率的相关性。术后早期他汀类药物使用定义为术后第一天内开始他汀类药物治疗。他汀类药物停药定义为术前他汀类药物治疗在手术前停止，直到术后至少第 2 天。采用逻辑回归和倾向评分模型来控制 AKI 的危险因素。324 例患者中 68 例（21.0%）发生 AKI。AKI 患者住院时间更长（p = 0.03），更易发生肺炎（p = 0.002）或死亡（p = 0.001）。较高的体重指数（p = 0.003）、较高的中心静脉压（p = 0.03）和他汀类药物停药（27.4%比 14.7%，p = 0.046）与 AKI 发生率较高相关，而术后早期他汀类药物使用具有保护作用（12.5%比 23.8%，p = 0.03）。术前他汀类药物使用并不影响 AKI 的风险。在多变量逻辑回归中，年龄（p = 0.03）、男性（p = 0.02）、体重指数（p < 0.001）和术后早期他汀类药物使用（比值比 = 0.32；95%置信区间，0.14-0.72；p = 0.006）独立预测 AKI。倾向评分调整后的风险评估证实了术后早期他汀类药物使用与 AKI 降低之间的相关性（比值比 = 0.30；95%置信区间，0.13-0.70；p = 0.005）。
结论
在慢性他汀类药物使用者和他汀类药物初治心脏手术患者中，术后早期他汀类药物使用与 AKI 发生率降低相关。
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