Skrlin Sara, Hou Vivian
Oregon Health and Science University, Portland, OR, USA.
Semin Cardiothorac Vasc Anesth. 2010 Dec;14(4):283-90. doi: 10.1177/1089253210386387. Epub 2010 Nov 1.
The leading cause of perioperative morbidity and mortality after major noncardiac surgery is cardiovascular complications. Clinical trials of lipid-lowering 3-hydroxy-3-methylglutaryl-coenzyme A (HMG-CoA) reductase inhibitors (statins) have shown improved cardiovascular outcomes; therefore, statins have become a mainstay in the prevention of cardiovascular disease. Retrospective trials and a small number of prospective randomized trials indicate that statin use may be beneficial during the perioperative period. In addition to the effects on serum lipid levels, statins influence inflammatory, thrombotic, and vasodilatory cellular pathways; and thus, their beneficial effects are not limited to patients with hypercholesterolemia. This review will (1) examine the evidence for using perioperative statin therapy in the noncardiac surgical patient (2) explore the possible consequences of statin withdrawal, and (3) revisit the evidence for the safety of statin use. Further studies are still needed to establish the optimal dosage as well as timing and length of statin therapy perioperatively.
非心脏大手术围手术期发病和死亡的主要原因是心血管并发症。降脂药物3-羟基-3-甲基戊二酰辅酶A（HMG-CoA）还原酶抑制剂（他汀类药物）的临床试验表明，心血管结局得到了改善；因此，他汀类药物已成为预防心血管疾病的主要手段。回顾性试验和少数前瞻性随机试验表明，围手术期使用他汀类药物可能有益。除了对血脂水平的影响外，他汀类药物还影响炎症、血栓形成和血管舒张细胞途径；因此，它们的有益作用不仅限于高胆固醇血症患者。本综述将（1）研究在非心脏手术患者中使用围手术期他汀类药物治疗的证据，（2）探讨停用他汀类药物可能产生的后果，以及（3）重新审视使用他汀类药物的安全性证据。仍需要进一步的研究来确定围手术期他汀类药物治疗的最佳剂量以及时机和疗程。
