Prehospital HMG Co-A Reductase Inhibitor Use and Reduced Mortality in Ruptured Abdominal Aortic Aneurysm
Prehospital HMG Co-A Reductase Inhibitor Use and Reduced Mortality in Ruptured Abdominal Aortic Aneurysm
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DOI：
10.1016/j.jamcollsurg.2009.03.005
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发表时间：
2009-07-01
影响因子：
5.2
通讯作者：
Jacobs, Lenworth M.
中科院分区：
文献类型：
--
作者：
Feeney, James M.;Burns, Karyl;Jacobs, Lenworth M.
背景技术背景：化合物3-羟基-3-甲基-戊二酰-CoA还原酶抑制剂（HMG Co-A还原酶抑制剂，他汀类药物）是用于控制血清胆固醇升高的常用药物。最近的证据表明，严重脓毒症、脓毒性休克或严重创伤患者在发病前服用他汀类药物可使其生存获益。研究设计：我们完成了一项回顾性研究，对2000年1月至2008年12月在我院发生的腹主动脉瘤破裂患者进行回顾性分析。我们比较了所有符合入选和排除标准的患者的年龄、性别、死亡率、生理和手术严重程度评分，以计算死亡率和死亡率（POSSUM）评分。我们比较了入院前使用和未使用他汀类药物的幸存者组的住院和ICU住院时间、心脏病发病率和每例患者的心脏事件数量。我们使用Pearson卡方检验比较死亡率、心脏病发病率和性别，使用Student t检验比较生理和手术严重程度评分计数死亡率和死亡率评分，使用Mann Whitney-U检验比较年龄和住院时间。未在院前使用他汀类药物组的死亡率为63.8%，在院前使用他汀类药物组的死亡率为34.8%（p = 0.018，比值比0.30至0.11）。生理和手术严重程度评分计数的死亡率和死亡率评分是相似的生存组和无他汀类药物的使用和非生存组使用他汀类药物。医院和ICU的住院时间，心脏病发病率，每例患者的心脏事件的数量没有统计学差异survivor.CONCLUSIONS：院前他汀类药物的使用似乎与一个显着的生存优势在破裂的腹主动脉瘤人群。（美国科尔外科杂志2009;209：41-46。(C)2009年美国外科医生学会）
BACKGROUND: The compounds 3-hydroxy-3-methyl-glutaryl-CoA reductase inhibitors (HMG Co-A reductase inhibitors, statins) are popular medications for the control of elevated serum cholesterol. Recent evidence has demonstrated a survival benefit to patients who take statins in the premorbid period with severe sepsis, septic shock, or severe trauma. We hypothesized that a similar benefit Would be seen in patients with ruptured abdominal aortic aneurysm.STUDY DESIGN: We completed a retrospective review of patients with ruptured abdominal aortic aneurysm in our institution from January 2000 to December 2008. We compared age, gender, mortality rates, and Physiologic and Operative Severity Score for the enumeration of Mortality and Morbidity (POSSUM) scores for all patients who met inclusion and exclusion criteria. We compared hospital and ICU lengths of stay, cardiac morbidity and number of cardiac events per patient between survivor groups with and without prehospital statin use. We compared mortality, cardiac morbidity, and gender using the Pearson chi-square test, Physiologic and Operative Severity Score for the enumeration of Mortality and Morbidity scores and age using the Student's t-test and lengths of stay using the Mann Whitney-U test.RESULTS: Mortality in the group without prehospital statin use was 63.8%, and in the group with prehospital statin use was 34.8% (p = 0.018, odds ratio 0.30 to 0.11). Physiologic and Operative Severity Score for the enumeration of Mortality and Morbidity scores were similar between survivor groups with and without statin use and nonsurvivor groups with and without statin use. Hospital and ICU lengths of stay, cardiac morbidity, and number of cardiac events per patient were not statistically different among survivors.CONCLUSIONS: Prehospital statin use appears to be associated with a significant survival benefit in the ruptured abdominal aortic aneurysm population. (J Am Coll Surg 2009;209:41-46. (C) 2009 by the American College of Surgeons)