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围手术期使用他汀类药物与镁的组合对心脏手术患者阿片类药物消耗的影响:一项倾向评分匹配的回顾性研究

The Impact of Perioperative Use of a Statin-Magnesium Combination on Opioid Consumption in Patients Who Underwent Cardiac Surgery: A Retrospective Study with Propensity-Score Matching.

作者信息

Lee Cheol, So Cheol Hwan

机构信息

Department of Anesthesiology and Pain Medicine, Wonkwang University School of Medicine, Iksan, Korea.

Department of Pediatrics, Wonkwang University School of Medicine, Iksan, Korea.

出版信息

Chonnam Med J. 2020 May;56(2):130-135. doi: 10.4068/cmj.2020.56.2.130. Epub 2020 May 25.

Abstract

Both statins and magnesium are associated with NMDA receptors and anti-inflammatory effect. Peripheral NMDA receptors are known to be involved in inflammation-induced pain. This study aimed to investigate the impact of perioperative use of a statin-magnesium combination on opioid consumption in patients who underwent cardiac surgery. This was a retrospective study of 542 patients who underwent cardiac surgery. The patients were divided into two groups according to statin use: the statin-magnesium group (n=375) and the magnesium-only group (n=167). Patients in the magnesium-only group received only perioperative magnesium, but no statins, to prevent atrial fibrillation following cardiac surgery. After propensity-score matching, 228 patients (n=114 in each group) were analyzed to investigate opioid consumption, visual analogue scale (VAS) pain scores over a 72-h period, and pain outcomes according to the duration of statin treatment (<1 or ≥1 yr). The consumed opioid volume was significantly smaller in statin-magnesium group than the magnesium-only group, both before (p=0.010) and after matching (p=0.017). The statin-magnesium combination did not significantly reduce the VAS pain scores compared with magnesium alone. Although the statin-magnesium combination did not significantly reduce the pain intensity compared with magnesium alone, the combination therapy was effective in reducing opioid consumption after surgery.

摘要

他汀类药物和镁都与N-甲基-D-天冬氨酸(NMDA)受体及抗炎作用有关。已知外周NMDA受体参与炎症诱导的疼痛。本研究旨在调查围手术期使用他汀类药物与镁的组合对接受心脏手术患者阿片类药物消耗量的影响。这是一项对542例接受心脏手术患者的回顾性研究。根据他汀类药物的使用情况将患者分为两组:他汀类药物与镁联合组(n = 375)和仅使用镁组(n = 167)。仅使用镁组的患者仅在围手术期接受镁,不使用他汀类药物,以预防心脏手术后的心房颤动。经过倾向得分匹配后,分析了228例患者(每组n = 114),以调查阿片类药物消耗量、72小时内的视觉模拟量表(VAS)疼痛评分以及根据他汀类药物治疗持续时间(<1或≥1年)的疼痛结果。他汀类药物与镁联合组在匹配前(p = 0.010)和匹配后(p = 0.017)消耗的阿片类药物量均显著低于仅使用镁组。与单独使用镁相比,他汀类药物与镁的组合并未显著降低VAS疼痛评分。虽然与单独使用镁相比,他汀类药物与镁的组合并未显著降低疼痛强度,但联合治疗在降低术后阿片类药物消耗量方面是有效的。

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