终止他汀治疗对心脏术后患者肱动脉内皮功能的影响

目的观察终止阿托伐他汀治疗对冠状动脉旁路手术患者术后血脂水平以及肱动脉内皮功能的影响。方法2i例冠心病患者术前服用阿托伐他汀钙片（20mg／d），于术后短期停药，分别检测术前及术后不同时间点肱动脉直径、反应性充血血流量并测定血清一氧化氮（N0）、血浆内皮素以及血脂的变化。结果术后停药与停药前比较，肱动脉血流介导的血管舒张反应（FMD）明显减小（6．3±0．2）％VS（11．2±0．5）％，肱动脉反应性充血血流量减低（4i2．6±50．4）％VS（568．7±47．6）％（均P〈0．05）；血清NO减少，内皮素增加（P〈0．05）。结论冠状动脉旁路手术患者术后停用他汀治疗可损伤内皮依赖性舒张功能，建议术后早期恢复他汀治疗。

Effects of statin withdrawal on brachial artery endothelial function in patients with major surgery

Objective To observe the effects of atorvastatin withdrawal on postoperative brachial artery endothelial function and blood lipids levels. Methods In 21 patients who had used atorvastatin （20 mg/d） and would undergo major vascular surgery,statin therapy was discontinued after major vascular surgery. Brachial artery diameter and blood flow velocity were measured with Doppler ultrasound both at basal and hyperemic conditions. The percentages of the increased brachial artery diameter and blood flow velocity at hyperemic condition were calculated as indicators for evaluating the vascular endothelial function. The blood plasma level of nitric oxide（NO） and blood lipids were also measured. Results The increased percentages of the brachial artery diameter and blood flow velocity at hyperemic condition were lower after statin withdrawal than those before statin withdracoal beore, （6.3 ± 0.2） % vs （11.2±0.5）% and （412.6± 50.4）% vs （568.7 ± 47.6）% （both P 〈0.05）. The plasma NO level was lower after statin withdrawal than that before statin withdrawal（ P 〈0.05）. Conclusion Withdrawal of statin is associated with endothelial dysfunction. The suggestion is that statin therapy begins early after major surgery in patients with coronary disease.