Feringa Harm H H, Bax Jeroen J, Boersma Eric, Kertai Miklos D, Meij Simon H, Galal Wael, Schouten Olaf, Thomson Ian R, Klootwijk Peter, van Sambeek Marc R H M, Klein Jan, Poldermans Don
Department of Anesthesiology, Erasmus Medical Center, Rotterdam, Netherlands.
Circulation. 2006 Jul 4;114(1 Suppl):I344-9. doi: 10.1161/CIRCULATIONAHA.105.000463.
Adverse perioperative cardiac events occur frequently despite the use of beta (beta)-blockers. We examined whether higher doses of beta-blockers and tight heart rate control were associated with reduced perioperative myocardial ischemia and troponin T release and improved long-term outcome.
In an observational cohort study, 272 vascular surgery patients were preoperatively screened for cardiac risk factors and beta-blocker dose. Beta-blocker dose was converted to a percentage of maximum recommended therapeutic dose. Heart rate and ischemic episodes were recorded by continuous 12-lead electrocardiography, starting 1 day before to 2 days after surgery. Serial troponin T levels were measured after surgery. All-cause mortality was noted during follow-up. Myocardial ischemia was detected in 85 of 272 (31%) patients and troponin T release in 44 of 272 (16.2%). Long-term mortality occurred in 66 of 272 (24.2%) patients. In multivariate analysis, higher beta-blocker doses (per 10% increase) were significantly associated with a lower incidence of myocardial ischemia (hazard ratio [HR], 0.62; 95% confidence interval [CI], 0.51 to 0.75), troponin T release (HR, 0.63; 95% CI, 0.49 to 0.80), and long-term mortality (HR, 0.86; 95% CI, 0.76 to 0.97). Higher heart rates during electrocardiographic monitoring (per 10-bpm increase) were significantly associated with an increased incidence of myocardial ischemia (HR, 2.49; 95% CI, 1.79 to 3.48), troponin T release (HR, 1.53; 95% CI, 1.16 to 2.03), and long-term mortality (HR, 1.42; 95% CI, 1.14 to 1.76).
This study showed that higher doses of beta-blockers and tight heart rate control are associated with reduced perioperative myocardial ischemia and troponin T release and improved long-term outcome in vascular surgery patients.
尽管使用了β受体阻滞剂，但围手术期心脏不良事件仍频繁发生。我们研究了更高剂量的β受体阻滞剂和严格的心率控制是否与围手术期心肌缺血及肌钙蛋白T释放减少以及改善长期预后相关。
在一项观察性队列研究中，对272例血管外科手术患者术前进行心脏危险因素和β受体阻滞剂剂量筛查。将β受体阻滞剂剂量换算为最大推荐治疗剂量的百分比。从手术前1天至手术后2天，通过连续12导联心电图记录心率和缺血发作情况。术后测量系列肌钙蛋白T水平。随访期间记录全因死亡率。272例患者中有85例（31%）检测到心肌缺血，272例中有44例（16.2%）出现肌钙蛋白T释放。272例患者中有66例（24.2%）发生长期死亡。在多变量分析中，更高剂量的β受体阻滞剂（每增加10%）与心肌缺血发生率降低（风险比[HR]，0.62；95%置信区间[CI]，0.51至0.75）、肌钙蛋白T释放（HR，0.63；95%CI，0.49至0.80）及长期死亡率降低（HR，0.86；95%CI，0.76至0.97）显著相关。心电图监测期间更高的心率（每增加10次/分钟）与心肌缺血发生率增加（HR，2.49；95%CI，1.79至3.48）、肌钙蛋白T释放（HR，1.53；95%CI，1.16至2.03）及长期死亡率增加（HR，1.42；95%CI，1.14至1.76）显著相关。
本研究表明，更高剂量的β受体阻滞剂和严格的心率控制与血管外科手术患者围手术期心肌缺血及肌钙蛋白T释放减少以及长期预后改善相关。
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