Auerbach Andrew D, Goldman Lee
Department of Medicine, Box 0120, University of California, San Francisco, San Francisco, CA 94143-0120, USA.
JAMA. 2002 Mar 20;287(11):1445-7. doi: 10.1001/jama.287.11.1445.
Recent studies suggest that beta-blockers administered perioperatively may reduce the risk of adverse cardiac events and mortality in patients who have cardiac risk factors and undergo major noncardiac surgery. The objective of this article is to provide practicing physicians with examples of perioperative beta-blocker use in practice by using several hypothetical cases. Although current evidence describing the effectiveness of perioperative beta-blockade may not address all possible clinical situations, it is possible to formulate an evidence-based approach that will maximize benefit to patients. We describe how information from several sources can be used to guide management of patients with limited exercise tolerance, those at highest risk for perioperative cardiac events, patients who are taking beta-blockers long-term, and those with relative contraindications to beta-blockade. Even though fine points of their use remain to be elucidated, perioperative beta-blocker use is important and can be easily applied in practice by any physician involved with the care of patients perioperatively.
近期研究表明，对于有心脏危险因素且接受大型非心脏手术的患者，围手术期使用β受体阻滞剂可能会降低不良心脏事件的风险和死亡率。本文的目的是通过几个假设病例，为执业医师提供围手术期使用β受体阻滞剂的实际案例。尽管目前描述围手术期β受体阻滞剂疗效的证据可能无法涵盖所有可能的临床情况，但制定一种基于证据的方法可以使患者受益最大化。我们描述了如何利用来自多个来源的信息来指导对运动耐量有限的患者、围手术期心脏事件风险最高的患者、长期服用β受体阻滞剂的患者以及有β受体阻滞剂相对禁忌证的患者的管理。尽管其使用的细节仍有待阐明，但围手术期使用β受体阻滞剂很重要，并且参与患者围手术期护理的任何医师都可以在实践中轻松应用。
