Angeli Fabio, Verdecchia Paolo, Karthikeyan Ganesan, Mazzotta Giovanni, Repaci Salvatore, del Pinto Maurizio, Gentile Giorgio, Cavallini Claudio, Reboldi Gianpaolo
Department of Cardiology, Hospital Santa Maria della Misericordia, Perugia, Italy.
Ther Adv Cardiovasc Dis. 2010 Apr;4(2):109-18. doi: 10.1177/1753944710361731. Epub 2010 Mar 3.
Myocardial ischemia is a frequent complication in patients undergoing non-cardiac surgery and beta-blockers may exert a protective effect. The main benefit of beta-blockers in perioperative cardiovascular morbidity and mortality is believed to be linked to specific effects on myocardial oxygen supply and demand. beta-blockers may exert anti-inflammatory and anti-arrhythmic effects. Randomized clinical trials which evaluated the effects of beta-blockers on all-cause mortality in patients undergoing non-cardiac surgery have yielded conflicting results. In 9 trials, 10,544 patients with non-cardiac surgery were randomized to beta-blockers (n = 5274) or placebo (n = 5270) and there were a total of 304 deaths. Patients randomized to beta-blockers group showed a 19% increased risk of all-cause mortality (odds ratio [OR] 1.19, 95% confidence interval (CI) 0.95-1.50; p = 0.135). However, trials included in the meta-analysis differed in several aspects, and a significant degree of heterogeneity (I( 2) = 46.5%) was noted. A recent analysis showed that the surgical risk category had a substantial influence on the overall estimate of the effect of beta-blockers. Compared with patients in the intermediate-high-surgical-risk category, those in the high-risk category showed a 73% reduction in the risk of total mortality with beta-blockers compared with placebo (OR 0.27, 95% CI 0.10-0.71, p = 0.016). These data suggest that perioperative beta-blockers confer a benefit which is mostly limited to patients undergoing high-risk surgery.
心肌缺血是接受非心脏手术患者的常见并发症，β受体阻滞剂可能具有保护作用。β受体阻滞剂在围手术期心血管发病率和死亡率方面的主要益处被认为与对心肌氧供需的特定影响有关。β受体阻滞剂可能具有抗炎和抗心律失常作用。评估β受体阻滞剂对接受非心脏手术患者全因死亡率影响的随机临床试验结果相互矛盾。在9项试验中，10544例接受非心脏手术的患者被随机分为β受体阻滞剂组（n = 5274）或安慰剂组（n = 5270），共有304例死亡。随机分配到β受体阻滞剂组的患者全因死亡率风险增加了19%（比值比[OR] 1.19，95%置信区间[CI] 0.95 - 1.50；p = 0.135）。然而，纳入荟萃分析的试验在几个方面存在差异，并且观察到显著程度的异质性（I² = 46.5%）。最近的一项分析表明，手术风险类别对β受体阻滞剂效果的总体评估有重大影响。与中高手术风险类别的患者相比，高风险类别的患者使用β受体阻滞剂与安慰剂相比，总死亡率风险降低了73%（OR 0.27，95% CI 0.10 - 0.71，p = 0.016）。这些数据表明，围手术期使用β受体阻滞剂的益处主要限于接受高风险手术的患者。
