围术期应用他汀类药物与全膝关节置换术后疼痛的关系
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Association between perioperative statin use and postoperative pain after total knee arthroplasty
背景与目的
目前尚不明确他汀类药物在围术期是否会增加或减少术后疼痛。本研究旨在探讨腰麻下全膝关节置换术后使用他汀类药物与疼痛的关系。
方 法
这是一项基于2005年1月至2017年10月间三级医院病历记录的回顾性观察研究。我们分析了在腰麻下行选择性全膝关节置换术患者的住院病历。比较围术期服用他汀类药物的患者与未服用他汀类药物的患者术后3天（POD）的疼痛发生情况。
结 果
最终分析共纳入了1088例患者(544例为他汀类药物组和544例非他汀类药物组)。术后3天（POD）他汀类药物组总吗啡使用量高于非他汀类药物组（均值（标准差），他汀类药物组为525.4（119.7），而非他汀类药物组为495.3（115.3），95%CI 15.9~44.4，p<0.001）。线性回归分析显示，他汀组术后3天摄入的吗啡总量比非他汀组高30.14 mg (95% CI 15.93 ~ 44.35;p < 0.001)。
结 论
围术期他汀类药物的使用与腰麻下全膝关节置换术后阿片类药物用量的显著增加有关。
原始文献摘要
Tak Kyu Oh, Chong Bum Chang, Hyun-Jung Shin. Association between perioperative statin use and postoperative pain after total knee arthroplasty[J]. Reg Anesth Pain Med 2019;44:221–226
Background and objectives Data is insufficient to determine whether perioperative statin use increases or decreases postoperative pain. This study aimed to investigate the association between perioperative statin use and pain outcomes after total knee arthroplasty performed under spinal anesthesia.
Methods This is a retrospective, observational study based on medical records from a tertiary hospital between January 2005 and October 2017. Medical records of patients who underwent elective total knee arthroplasty under spinal anesthesia as inpatients
were analyzed. Pain outcomes were compared through postoperative day (POD) 3 in patients who were taking statins perioperatively versus patients who were not taking statins.
results A total of 1088 propensity-matched participants were included in the final analysis (544 patients in the statin group and 544 patients in the non-statin group). The total morphine equivalent consumption through POD 3 was higher in the statin
group than in the non-statin group (mean (SD), statin group: 525.4 (119.7) vs non-statin group: 495.3 (115.3),95% CI of the difference: 15.9 to 44.4, p<0.001). In the linear regression analysis, the total morphine equivalent consumption through POD 3 was 30.14 mg higher in the statin group compared with the non-statin group (95%CI 15.93 to 44.35; p<0.001).
Conclusions Perioperative statin use is associated with a significant increase in postoperative opioid consumption after total knee arthroplasty performed under spinal anesthesia; however, this increase was so marginal that its clinical importance remains controversial.
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贵州医科大学高鸿教授课题组
翻译：唐剑 编辑：何幼芹 审校：王贵龙