Koelemay M J W, Legemate D A
Academisch Medisch Centrum, Universiteit van Amsterdam, Afd. Chirurgie, G5-153, Postbus 22.600, 1100 DD Amsterdam.
Ned Tijdschr Geneeskd. 2008 Nov 29;152(48):2603-5.
The results of the recently published PeriOperative ISchemic Evaluation (POISE) trial show that perioperative use of metoprolol in patients with atherosclerosis undergoing major non-cardiac surgery reduces the risk of cardiovascular complications. This effect was primarily produced by a 1.5% reduction in non-fatal myocardial infarction (MI), but this advantage was outweighed by a 0.8% increase in total mortality and a 0.5% increase in nonfatal stroke. These results, combined with previous meta-analyses, confirm that non-fatal MI is reduced at the cost of a statistically significant increase in stroke rate and a near significant increase in mortality. It is likely that the increase in complications is due to a high dose of metoprolol being given too shortly before the operation. These findings call for judicious perioperative use of adrenergic beta-antagonists in cardiac-high-risk patients undergoing high risk non-cardiac surgery. Dosage should be lower and administration should be implemented longer before the operation.
最近发表的围手术期缺血评估（POISE）试验结果表明，在接受非心脏大手术的动脉粥样硬化患者中围手术期使用美托洛尔可降低心血管并发症风险。这一效果主要源于非致命性心肌梗死（MI）发生率降低了1.5%，但这一优势被总死亡率增加0.8%和非致命性中风增加0.5%所抵消。这些结果与之前的荟萃分析相结合，证实非致命性心肌梗死的减少是以中风发生率有统计学意义的增加和死亡率近乎显著的增加为代价的。并发症增加可能是由于在手术前过早给予高剂量美托洛尔所致。这些发现呼吁在接受高风险非心脏手术的心脏高危患者围手术期谨慎使用肾上腺素能β受体阻滞剂。剂量应更低，且应在手术前更长时间给药。
