大剂量辛伐他汀术前应用对左至右分流型先天性心脏病肺动脉压的影响
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篇名: 大剂量辛伐他汀术前应用对左至右分流型先天性心脏病肺动脉压的影响
TITLE:
摘要: 目的:探讨大剂量辛伐他汀术前应用对左至右分流型先天性心脏病(CHD)肺动脉压的影响。方法:86例拟行介入封堵治疗的左至右分流型CHD伴肺动脉高压患者分为对照组(43例)和观察组(43例)。两组患者术前均给予洋地黄类、利尿药、抗凝药等常规治疗。在此基础上,对照组患者给予枸橼酸西地那非片25 mg,每日3次,餐前1 h空腹口服;观察组患者口服辛伐他汀片80 mg,每晚1次。两组疗程均为7 d。观察两组患者治疗前后平均肺动脉压(mPAP)、N端脑钠肽激素原(NT-proBNP)、动脉血氧饱和度(SaO2)、动脉血氧分压(PaO2)、肺体循环血流量比(Qq/Qs)、肺动脉压力变化(Rp/Rs)、肺血管阻力指数(PVRi)、肝功能[丙氨酸转氨酶(ALT)、天冬氨酸转氨酶(AST)]和心肌酶学[乳酸脱氢酶(LDH)、肌酸激酶同工酶(CKMB)]水平及不良反应发生情况。结果:治疗前,两组患者mPAP、NT-proBNP、SaO2、PaO2、Qq/Qs、Rp/Rs、PVRi、ALT、AST、LDH、CKMB水平比较,差异均无统计学意义(P>0.05)。治疗后,两组患者mPAP、NT-proBNP、Rp/Rs、PVRi水平均显著低于同组治疗前,SaO2、PaO2、Qq/Qs水平均显著高于同组治疗前,且观察组Qq/Qs高于对照组,差异均有统计学意义(P<0.05)。观察组1例患者出现肝功能明显异常,退出试验;其余患者未见严重不良反应发生。结论:大剂量辛伐他汀术前应用对左至右分流型CHD患者,可显著降低mPAP、NT-proBNP、Rp/Rs、PVRi水平,升高SaO2、PaO2、Qq/Qs水平,且安全性较好。
ABSTRACT: OBJECTIVE: To investigate the effect of preoperative use of high-dose simvastatin on the pulmonary artery pressure in congenital heart disease with left-to-right shunt. METHODS: 86 patients with left-to-right shunt congenital heart disease who were planned to implement interventional occlusion therapy were randomly divided into control group(43 cases) and observation group(43 cases). Patients in both groups were given digitalis,diuretics,anticoagulants and other basic treatments; On this basis,control group received Sildenafil citrate tablet, 25 mg, 3 times a day, orally given 1 h before a meal; observation group received Simvastatin tablet 80 mg, once every evening, orally. The treatment course for both groups was 7 d. Mean pulmonary hypertension (mPAP), N terminal prohormone brain natriuretic peptide (NT-proBNP), arterial oxygen saturation (SaO2), arterial oxygen tension (PaO2), pulmonary blood circulation ratio (Qq/Qs), pulmonary pressure variation (Rp/Rs), pulmonary vascular resistance index (PVRi) before and after treatment in 2 groups were observed, and related indicators of liver functions [alanine aminotransferase (ALT), aspartate aminotransferase(AST)] and myocardial enzymes [lactate dehydrogenase (LDH), creatine kinase MB(CKMB)] were detected. The incidence of adverse reactions were deteted. RESULTS: Before treatment, there were no significant differences in mPAP, NT-proBNP, SaO2,PaO2, Qq/Qs, Rp/Rs, PVRi, ALT, AST, LDH and CKMB levels in 2 groups (P>0.05). After treatment, mPAP, NT-proBNP, Rp/Rs and PVRi levels were significantly lower than before, SaO2, PaO2, and Qq/Qs levels were significantly higher than before and Qq/Qs level in observation group was higher than these in control group.The difference was statistically significant (P<0.05). There was 1 patient showed severe liver injury in observation group and exited the test; the other 85 patients showed no obvious adverse reactions, with successful surgery and good prognosis. CONCLUSIONS: The preoperative use of high-dose simvastatin shows obvious effect on controlling mean pulmonary hypertension, reducing mPAP, NT-proBNP, Rp/Rs and PVRi levels and increasing SaO2, PaO2, and Qq/Qs levels before operation, with good safety.
期刊: 2016年第27卷第18期
作者: 张建堂,王辉宇,王志太
AUTHORS: ZHANG Jiantang,WANG Huiyu,WANG Zhitai
关键字: 左至右分流型先天性心脏病;辛伐他汀;肺动脉压;N 端脑钠肽激素原;动脉血氧饱和度;动脉血氧分压
KEYWORDS: Congenital heart disease with left-to-right shunt; Simvastatin; PAP; NT-proBNP; SaO2; PaO2
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