阿托伐他汀钙在老年脓毒性休克患者炎症控制中的作用

Effect of Atorvastatin Calcium on Inflammation Control in Elderly Patients with Septic Shock

关键词:  阿托伐他汀钙  老年患者  脓毒性休克  炎症  炎症控制

Key words:  atorvastatin calcium  elderly patients  septic shock  inflammation  inflammation control

摘要:

目的 探讨阿托伐他汀钙在老年脓毒性休克患者炎症控制中的作用。方法 采用前瞻性随机对照研究的方法，将2019年1月—2019年12月宁波市医疗中心李惠利医院东部院区重症医学科（intensive care unit，ICU）收治的老年脓毒性休克患者，随机分为他汀组和对照组，对照组采用常规综合支持治疗，他汀组在对照组的基础上加用阿托伐他汀钙。记录2组患者的年龄、性别、病因、急性生理学与慢性健康状况评分Ⅱ（APACHE Ⅱ）等基本资料；观察并记录患者治疗前及治疗后第1天、第3天、第7天的C反应蛋白、前降钙素、体温波动、白细胞计数、中心静脉-动脉二氧化碳分压差[P_（v-a）CO₂，GAP]和中心静脉-动脉二氧化碳分压差/动脉-中心静脉氧含量差[P_（v-a）CO₂/C_（a-v）O₂，GAP ratio]等临床指标；记录2组患者28 d存活率、机械通气时间、ICU平均住院时间、总住院天数等预后指标。结果 最终研究纳入86例患者，2组基本资料差异无统计学意义。在治疗前和治疗后第1天，2组临床指标对比无差异；在治疗后第3，7天，他汀组临床指标的改善均优于对照组（P<0.05）；并且随着时间的推移，2组不同组间与检测时间点对各临床指标的改善均存在交互作用（P<0.05），提示越早应用阿托伐他汀钙，患者临床指标的改善越明显。2组预后对比，他汀组患者28 d存活率、机械通气时间、ICU平均住院和总住院时间均优于对照组。结论 应用阿托伐他汀钙可以改善老年脓毒性休克患者的炎症和全身灌注情况，可提高患者28 d存活率，减少机械通气时间、ICU平均住院时间和总住院时间，且越早应用获益越多。

Abstract:

OBJECTIVE To explore the role of atorvastatin calcium in the inflammatory control of elderly patients with septic shock. METHODS A prospective randomized controlled clinical study was used to treat elderly patients with septic shock from January 2019 to December 2019 in intensive care unit(ICU), eastern section of Lihuili Hospital, Ningbo Medical Center. The patients were randomly divided into statin group and control group by random number table method. Control group received conventional comprehensive supportive treatment, statin group was added with statins on the basis of control group. The basic data such as age, gender, etiology, APACHE II were recorded. Inflammatory and systemic perfusion indicators: C-reactive protein, procalcitonin, temperature, white blood cell count, GAP, GAP ratio were observed and recorded before and 1, 3, 7 d after treatment. Patients’ 28-day survival rate, mechanical ventilation days, ICU hospitalization days, totally hospitalization days and other prognosis indexes were also recorded. RESULTS Eighty six patients were selected in the study ultimately. There was no significant difference of the basic data difference between two groups. Comparison of clinical indicators between two groups showed no difference before treatment and the 1 d after treatment. On the 3 d and 7 d after treatment, the improvement of clinical indicators in the statin group were better than that of the control group(P<0.05). Over time, there was an interaction between different groups and detection time points on clinical indicators(P<0.05), suggesting that the earlier application of atorvastatin calcium, the more improvement of the patient’s clinical indicators. Compared with control group, patients’ 28-day survival rate, mechanical ventilation days ICU hospital days and totally hospital days in statin group was significantly improved. CONCLUSION Atorvastatin calcium can improve the inflammation and systemic perfusion of the elderly patients with septic shock, which may improve the 28-day survival rate, reduce the mechanical ventilation time, length of stay in ICU and totally length of hospital days. The earlier taking of atorvastatin calcium, the more benefit to elderly patients with septic shock.