First Anesthesia Department, Meizhou People's Hospital, Guangdong Province, China.
Eur Rev Med Pharmacol Sci. 2018 Mar;22(6):1798-1811. doi: 10.26355/eurrev_201803_14599.
Non-cardiac surgery is associated with perioperative cerebral complications (delirium, postoperative cognition dysfunction, stroke). While rare, these complications can lead to disabilities and deaths. Information is ambiguous as to whether pharmacological preoperative treatment exerts neuroprotection. We wished to systematically assess potential modulation by statins, lidocaine, ketamine or magnesium sulfate of the relative risk of cerebral complications in noncardiac surgery. Selection of these pharmacological agents was based on their known neuroprotective abilities.
By searching Medline, EMBASE and Cochrane databases, we identified 4 suitable publications that collectively enrolled 1358 patients (intent-to-treat population), of which 679 patients were treated preoperatively with statins (404 patients on atorvastatin and 275 on rosuvastatin) and 679 patients with preoperative placebo. The reported cerebral outcome was stroke, assessed either within 30 days (4 publications) or 6 months (2 publications) after surgery.
Episodes of stroke within 30 days and 6 months postoperatively were observed in several publications, enabling aggregate analyses. No modulation by statins of the relative risk of stroke at 30 days was observed (risk ratio 1.59, 95% confidence interval 0.08-30.97; p = 0.76). At 6 months, statins showed an insignificant trend toward neuroprotection (risk ratio 0.33, 95% confidence interval 0.05-2.10; p = 0.24).
The available clinical data are still scarce. Our analyses indicate no protective effects by statins against perioperative stroke but some favorable trends toward delayed stroke. Further randomized trials are needed to unequivocally assess the neuroprotective potential of current pharmacological agents in non-cardiac surgery.
非心脏手术与围手术期脑并发症（谵妄、术后认知功能障碍、中风）相关。虽然这些并发症很少见，但它们可能导致残疾和死亡。目前尚不清楚术前药物治疗是否具有神经保护作用。我们希望系统评估他汀类药物、利多卡因、氯胺酮或硫酸镁是否能调节非心脏手术中脑并发症的相对风险。选择这些药物治疗的依据是它们已知的神经保护能力。
通过搜索 Medline、EMBASE 和 Cochrane 数据库，我们确定了 4 项符合条件的研究，这些研究共纳入了 1358 名患者（意向治疗人群），其中 679 名患者接受了术前他汀类药物治疗（404 名阿托伐他汀治疗，275 名瑞舒伐他汀治疗），679 名患者接受了术前安慰剂治疗。报告的脑结局是中风，评估时间分别为术后 30 天（4 项研究）和 6 个月（2 项研究）。
几项研究中观察到术后 30 天和 6 个月的中风发作，从而可以进行汇总分析。他汀类药物对 30 天内中风的相对风险没有调节作用（风险比 1.59，95%置信区间 0.08-30.97；p = 0.76）。6 个月时，他汀类药物显示出神经保护的无显著性趋势（风险比 0.33，95%置信区间 0.05-2.10；p = 0.24）。
目前可用的临床数据仍然有限。我们的分析表明，他汀类药物不能预防围手术期中风，但对延迟性中风有一些有利趋势。需要进一步的随机试验来明确评估当前药物在非心脏手术中的神经保护潜力。
