围术期应用对氟伐他汀可以改善瓣膜术后的临床效果

收藏分享 2009-9-30 18:18| 发布者: tianniao| 查看数: 89| 评论数: 0

研究问题：围术期抑素治疗是否能改善行血管手术后的患者术后不良心脏事件的发生率？
方法：作者报告了DECREASE III期试验的结果，这项随机盲法安慰剂对照试验对氟伐他汀（每天80 mg）与安慰剂进行比较。试验开始于术前（中位数37天），受试者为年龄>40岁、行主动脉大手术、外周血管分流术或颈动脉内膜切除术的患者。主要结果为手术30天内发生心肌缺血（心电图的短暂变化、肌钙蛋白升高、或两者兼有）。次要结果为死于心血管疾病或心肌梗死（MI）的发生率。同时，在随机分组时和术前测定脂质、白介素-6和C-反应蛋白水平。
结果：497名受试者中，250名接受氟伐他汀治疗，247名接受安慰剂治疗。手术时，治疗组低密度脂蛋白、总胆固醇、白介素-6和C-反应蛋白均显著较低，而安慰剂组无变化。氟伐他汀组发生心肌缺血的次数明显少于安慰剂组[分别为 27（10.8%）和47（19.0%）；危险比（HR）0.55；95%可信区间（CI）0.34-0.88；p = 0.01]。死于心血管疾病或MI的死亡率氟伐他汀组也少于安慰剂组[分别为12（4.8%）和25（10.1%）；HR 0.47；95%CI 0.24-0.94；p = 0.03]。
结论：作者的结论是，行血管手术的患者中，围术期氟伐他汀治疗可改善术后心脏结局。

医学岛推荐原文“
Study Question: Does perioperative statin therapy improve postoperative incidence of adverse cardiac events in patients undergoing vascular surgery?
Methods: The authors reported the results of the DECREASE III trial, a randomized, blinded, placebo-controlled trial of fluvastatin 80 mg daily versus placebo, started prior to surgery (median 37 days), in subjects >age 40 undergoing major aortic, peripheral vascular bypass, or carotid endarterectomy surgery. The primary endpoint was myocardial ischemia (transient changes on electrocardiogram, tropinin elevation, or both), within 30 days of surgery. Secondary endpoint was death from cardiovascular causes or myocardial infarction (MI). Also, lipids, interleukin-6, and C-reactive protein levels were measured at the time of randomization and before surgery.
Results: Among 497 subjects, 250 received fluvastatin, and 247 received placebo. By the time of surgery, low-density lipoprotein, total cholesterol, interleukin-6, and C-reactive protein were all significantly lower in the treatment group, but unchanged in the placebo group. Myocardial ischemia was much less frequent in the fluvastatin versus placebo groups (27 [10.8%] vs. 47 [19.0%], respectively; hazard ratio [HR], 0.55; 95% confidence interval [CI], 0.34-0.88; p = 0.01). Death from cardiovascular causes or MI were also less frequent in the fluvastatin versus placebo groups (12 [4.8%] vs. 25 [10.1%], respectively; HR, 0.47; 95% CI, 0.24-0.94; p = 0.03).
Conclusions: The authors concluded that among patients undergoing vascular surgery, perioperative fluvastatin therapy was associated with an improvement in postoperative cardiac outcome.

http://content.nejm.org/cgi/content/abstract/361/10/980

关闭安全验证

围术期应用对氟伐他汀可以改善瓣膜术后的临床效果

最新评论

相关分类

关闭 安全验证

围术期应用对氟伐他汀可以改善瓣膜术后的临床效果

最新评论

相关分类

关闭安全验证