Coleman Craig I, Perkerson Kristen A, Gillespie Effie L, Kluger Jeffrey, Gallagher Robert, Horowitz Sheryl, White C Michael
School of Pharmacy, University of Connecticut, Storrs, CT, USA.
Ann Pharmacother. 2004 Dec;38(12):2012-6. doi: 10.1345/aph.1E310. Epub 2004 Oct 26.
Previous studies have shown that post-cardiothoracic surgery atrial fibrillation (AF) increases the risk of hospital length of stay (LOS), overall mortality, pulmonary edema, and need for a balloon pump. A meta-analysis of 2 previous trials showed a nonsignificant reduction in LOS with postoperative beta-blockers but only encompassed 1200 patients, with few valve surgery patients, and neither study used a hospital within the US.
To evaluate the impact of postoperative beta-blockers on LOS and AF. Secondary endpoints of overall mortality, pulmonary edema, and need for an intra-aortic balloon pump (IABP) were also evaluated between groups.
This was a prospective cohort evaluation of all patients undergoing cardiothoracic surgery at our institution between October 1999 and October 2003. Patients receiving prophylactic postoperative beta-blockers were matched (1:1) with patients not receiving prophylaxis for age >70 years, valvular surgery, history of AF, gender, and use of preoperative digoxin and beta-blockers.
Patients (n = 1660) receiving postoperative beta-blockade had a reduction in LOS (mean +/- SD 10.22 +/- 11.38 vs 12.40 +/- 15.67; p = 0.001) and AF (23.5% vs 28.4%; p = 0.02). Mortality, pulmonary edema, and need for IABP were reduced by >50% (p < 0.001; p = 0.001; p < 0.001, respectively), while myocardial infarction and stroke were not significantly impacted.
In this observational cohort study, prophylactic postoperative beta-blocker use was associated with shorter hospital LOS by an average of 2.2 days and a 17.3% lower incidence of AF. It may also be associated with reductions in overall mortality, pulmonary edema, and need for an IABP.
先前的研究表明，心胸外科手术后房颤会增加住院时间（LOS）、总体死亡率、肺水肿以及使用球囊泵的风险。对之前两项试验的荟萃分析显示，术后使用β受体阻滞剂可使住院时间略有缩短，但差异无统计学意义，且该分析仅纳入了1200例患者，其中瓣膜手术患者较少，两项研究均未在美国的医院进行。
评估术后使用β受体阻滞剂对住院时间和房颤的影响。同时，还对两组患者的总体死亡率、肺水肿以及使用主动脉内球囊泵（IABP）的需求等次要终点进行了评估。
这是一项对1999年10月至2003年10月期间在本机构接受心胸外科手术的所有患者进行的前瞻性队列评估。将术后接受预防性β受体阻滞剂治疗的患者与未接受预防性治疗的患者按年龄>70岁、瓣膜手术、房颤病史、性别以及术前是否使用地高辛和β受体阻滞剂进行1:1匹配。
接受术后β受体阻滞剂治疗的患者（n = 1660）住院时间缩短（平均±标准差为10.22±11.38天 vs 12.40±15.67天；p = 0.001），房颤发生率降低（23.5% vs 28.4%；p = 0.02）。死亡率、肺水肿以及使用IABP的需求降低了50%以上（分别为p < 0.001；p = 0.001；p < 0.001），而心肌梗死和中风未受到显著影响。
在这项观察性队列研究中，术后预防性使用β受体阻滞剂与住院时间平均缩短2.2天以及房颤发生率降低17.3%相关。它还可能与总体死亡率、肺水肿以及使用IABP的需求降低有关。
