van Gestel Yvette R B M, Hoeks Sanne E, Sin Don D, Welten Gijs M J M, Schouten Olaf, Witteveen Han J, Simsek Cihan, Stam Henk, Mertens Frans W, Bax Jeroen J, van Domburg Ron T, Poldermans Don
Department of Anesthesiology, Erasmus Medical Center, Rotterdam, The Netherlands.
Am J Respir Crit Care Med. 2008 Oct 1;178(7):695-700. doi: 10.1164/rccm.200803-384OC. Epub 2008 Jun 19.
beta-Blocker use is associated with improved health outcomes in patients with cardiovascular disease. There is a general reluctance to prescribe beta-blockers in patients with chronic obstructive pulmonary disease (COPD) because they may worsen symptoms.
We investigated the relationship between cardioselective beta-blockers and mortality in patients with COPD undergoing major vascular surgery.
We evaluated 3,371 consecutive patients who underwent major vascular surgery at one academic institution between 1990 and 2006. The patients were divided into those with and without COPD on the basis of symptoms and spirometry. The major endpoints were 30-day and long-term mortality after vascular surgery. Patients were defined as receiving low-dose therapy if the dosage was less than 25% of the maximum recommended therapeutic dose; dosages higher than this were defined as intensified dose.
There were 1,205 (39%) patients with COPD of whom 462 (37%) received cardioselective beta-blocking agents. beta-Blocker use was associated independently with lower 30-day (odds ratio, 0.37; 95% confidence interval, 0.19-0.72) and long-term mortality in patients with COPD (hazards ratio, 0.73; 95% confidence interval, 0.60-0.88). Intensified dose was associated with both reduced 30-day and long-term mortality in patients with COPD, whereas low dose was not.
Cardioselective beta-blockers were associated with reduced mortality in patients with COPD undergoing vascular surgery. In carefully selected patients with COPD, the use of cardioselective beta-blockers appears to be safe and associated with reduced mortality.
β受体阻滞剂的使用与心血管疾病患者健康状况的改善相关。慢性阻塞性肺疾病（COPD）患者一般不愿使用β受体阻滞剂，因为它们可能会加重症状。
我们研究了选择性β受体阻滞剂与接受大血管手术的COPD患者死亡率之间的关系。
我们评估了1990年至2006年间在一家学术机构接受大血管手术的3371例连续患者。根据症状和肺功能测定将患者分为有COPD和无COPD两组。主要终点是血管手术后30天和长期死亡率。如果剂量小于最大推荐治疗剂量的25%，则患者被定义为接受低剂量治疗；高于此剂量则被定义为强化剂量。
有1205例（39%）患者患有COPD，其中462例（37%）接受了选择性β受体阻滞剂治疗。在COPD患者中，使用β受体阻滞剂与较低的30天死亡率（比值比，0.37；95%置信区间，0.19 - 0.72）和长期死亡率独立相关（风险比，0.73；95%置信区间，0.60 - 0.88）。强化剂量与COPD患者30天和长期死亡率的降低均相关，而低剂量则不然。
选择性β受体阻滞剂与接受血管手术的COPD患者死亡率降低相关。在经过精心挑选的COPD患者中，使用选择性β受体阻滞剂似乎是安全的，且与死亡率降低相关。
