Sedrakyan Artyom, Treasure Tom, Browne John, Krumholz Harlan, Sharpin Carlos, van der Meulen Jan
Clinical Effectiveness Unit, Royal College of Surgeons of England, London, 35-43 Lincoln's Inn Fields, London WC2A 3PE, England, UK.
J Thorac Cardiovasc Surg. 2005 May;129(5):997-1005. doi: 10.1016/j.jtcvs.2004.07.042.
Atrial tachyarrhythmia is the most common complication after general thoracic surgery and is associated with significant morbidity, longer hospital stay, and higher costs. We sought to determine whether the use of antiarrhythmic medications is associated with a reduced rate of postoperative atrial tachyarrhythmia.
MEDLINE, EMBASE, Cochrane Database of clinical trials (1980-2003), and reference lists of relevant articles were searched for randomized controlled trials with placebo control, general thoracic patients, and noncombined and prophylactic use of the medications. Search, data abstraction, and analyses were performed and confirmed by at least 2 authors. A fixed-effects model was used to perform meta-analyses.
There were 11 unique trials (total n = 1294) that met the inclusion criteria. Calcium-channel blockers and beta-blockers reduced the risk of atrial tachyarrhythmia in 4 and 2 trials, respectively (relative risk of 0.50 and 95% confidence interval of 0.34-0.73; relative risk of 0.40 and 95% confidence interval of 0.17-0.95, respectively). However, beta-blockers tended to increase the risk of pulmonary edema (relative risk, 2.15; 95% confidence interval, 0.74-6.23). Magnesium tested in one unblinded trial also reduced the risk of atrial tachyarrhythmia (relative risk, 0.4; 95% confidence interval, 0.21-0.78). On the other hand, digitalis preparations were found to be harmful because they increased the risk of atrial tachyarrhythmia in 3 trials (relative risk, 1.51; 95% confidence interval, 1.00-2.28). Finally, 2 other medications, flecainide and amiodarone, were each tested in a single small trial, and their effects were associated with great uncertainty.
Calcium-channel blockers and beta-blockers are effective in reducing postoperative atrial tachyarrhythmia. The use of these medications should be individualized, and possible adverse events of beta-blockers should be taken into account. Randomized clinical trials do not support the use of digitalis in general thoracic surgery. The value of magnesium as a supplement to a main prophylactic regimen should be explored.
房性快速心律失常是胸外科手术后最常见的并发症，与显著的发病率、更长的住院时间和更高的费用相关。我们试图确定使用抗心律失常药物是否与降低术后房性快速心律失常的发生率相关。
检索MEDLINE、EMBASE、Cochrane临床试验数据库（1980 - 2003年）以及相关文章的参考文献列表，以查找采用安慰剂对照、纳入胸科手术患者且药物非联合及预防性使用的随机对照试验。检索、数据提取和分析由至少两名作者进行并确认。采用固定效应模型进行荟萃分析。
有11项独特的试验（总计n = 1294）符合纳入标准。钙通道阻滞剂和β受体阻滞剂分别在4项和2项试验中降低了房性快速心律失常的风险（相对风险分别为0.50，95%置信区间为0.34 - 0.73；相对风险为0.40，95%置信区间为0.17 - 0.95）。然而，β受体阻滞剂倾向于增加肺水肿的风险（相对风险为2.15；95%置信区间为0.74 - 6.23）。在一项非盲法试验中测试的镁也降低了房性快速心律失常的风险（相对风险为0.4；95%置信区间为0.21 - 0.78）。另一方面，发现洋地黄制剂有害，因为在3项试验中它们增加了房性快速心律失常的风险（相对风险为1.51；95%置信区间为1.00 - 2.28）。最后，另外两种药物，氟卡尼和胺碘酮，分别在一项小型试验中进行了测试，它们的效果存在很大不确定性。
钙通道阻滞剂和β受体阻滞剂在降低术后房性快速心律失常方面有效。这些药物的使用应个体化，并应考虑β受体阻滞剂可能的不良事件。随机临床试验不支持在胸外科手术中使用洋地黄。应探索镁作为主要预防方案补充剂的价值。
