急性手术性贫血影响β受体阻滞剂的心脏保护作用：一项单中心、倾向评分匹配队列研究。

Acute surgical anemia influences the cardioprotective effects of beta-blockade: a single-center, propensity-matched cohort study.

机构信息

Department of Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.

出版信息

Anesthesiology. 2010 Jan;112(1):25-33. doi: 10.1097/ALN.0b013e3181c5dd81.

DOI:10.1097/ALN.0b013e3181c5dd81

PMID:20032700

Abstract

BACKGROUND

Despite decreasing cardiac events, perioperative beta-blockade also increases perioperative stroke and mortality. Major bleeding and/or hypotension are independently associated with these outcomes. To investigate the hypothesis that beta-blockade limits the cardiac reserve to compensate for acute surgical anemia, the authors examined the relationship between cardiac events and acute surgical anemia in patients with and without beta-blockade.

METHODS

The records of all noncardiac, nontransplant surgical patients between March 2005 and June 2006 were retrospectively retrieved. The primary outcome was a composite that comprised myocardial infarction, nonfatal cardiac arrest, and in-hospital mortality (major adverse cardiac event). The lowest recorded hemoglobin in the first 3 days defined nadir hemoglobin. Propensity scores estimating the probability of receiving a perioperative beta-blocker were used to match (1:1) patients who did or did not receive beta-blockers postoperatively. The relationship between nadir hemoglobin and major adverse cardiac event was then assessed.

RESULTS

This analysis identified 4,387 patients in whom nadir hemoglobin could be calculated; 1,153 (26%) patients were administered beta-blockers within the first 24 h of surgery. Propensity scores created 827 matched pairs that were well balanced for all measured confounders. Major adverse cardiac event occurred in 54 (6.5%) beta-blocked patients and in 25 (3.0%) beta-blocker naive patients (relative risk 2.38; 95% CI 1.43-3.96; P = 0.0009). The restricted cubic spline relationship demonstrated that this difference was restricted to those patients in whom the hemoglobin decrease exceeded 35% of the baseline value.

CONCLUSIONS

beta-Blocked patients do not seem to tolerate surgical anemia when compared with patients who are naive to beta-blockers. Prospective studies are required to validate these findings.

摘要

背景

尽管围手术期β受体阻滞剂降低了心脏事件的发生率，但也增加了围手术期卒中发生率和死亡率。大出血和/或低血压与这些结果独立相关。为了研究β受体阻滞剂是否限制了心脏储备以代偿急性手术性贫血的假说，作者研究了有或无β受体阻滞剂的患者中心脏事件与急性手术性贫血之间的关系。

方法

回顾性检索了 2005 年 3 月至 2006 年 6 月期间所有非心脏、非移植手术患者的记录。主要结果是包括心肌梗死、非致命性心脏骤停和院内死亡率（主要不良心脏事件）的复合结果。前 3 天记录的最低血红蛋白定义为血红蛋白最低值。使用估计接受围手术期β受体阻滞剂概率的倾向评分对术后接受或未接受β受体阻滞剂的患者进行 1:1 匹配。然后评估血红蛋白最低值与主要不良心脏事件之间的关系。

结果

该分析确定了 4387 例可计算血红蛋白最低值的患者，其中 1153 例（26%）患者在手术的前 24 小时内接受了β受体阻滞剂。倾向评分创建了 827 对匹配对，在所有测量的混杂因素方面均得到很好的平衡。54 例（6.5%）接受β受体阻滞剂的患者和 25 例（3.0%）未接受β受体阻滞剂的患者发生主要不良心脏事件（相对风险 2.38；95%置信区间 1.43-3.96；P=0.0009）。受限立方样条关系表明，这种差异仅限于血红蛋白下降超过基线值 35%的患者。