Heim Kathryn A, Lachiewicz Mark P, Soileau Elizabeth S, Lachiewicz Paul F
Fort Worth Affiliated Hospitals Orthopaedic Residency Program at JPS Health Network, Fort Worth, TX, USA.
J Surg Orthop Adv. 2010 Fall;19(3):162-5.
Cardiac complications are an infrequent yet undesirable cause of morbidity and mortality following total knee arthroplasty. Perioperative prophylaxis with beta-blocker medication has been shown to reduce in-hospital cardiac deaths in noncardiac surgical patients. This study evaluated the safety and in-hospital cardiac complications of a consecutive cohort of 267 total knee arthroplasties in patients who followed a perioperative beta-blocker prophylaxis institutional protocol. The patients were categorized into three groups: A, already on a beta-blocker; B, beta-blocker prescribed by orthopaedic surgeon; and C, not given the medication. The 90-day mortality and in-hospital cardiac complications were evaluated. Of the patients who had 267 procedures, 203 (76%) received beta-blocker prophylaxis perioperatively: 110 (41.2%) were already on the medication preoperatively, 93 (34.8%) were prescribed the medication by the surgeon, and 64 (24%) did not receive this medication. There were no deaths within the first 90 days. There were two nonfatal myocardial infarctions (0.7%) and six other cardiac complications (2.2%). With a beta-blocker prophylaxis protocol implemented by one surgeon, 76% of total knee arthroplasty patients were given the medication and it was prescribed in 34.8% by the orthopaedic surgeon. In-hospital cardiac complications were low.
心脏并发症是全膝关节置换术后发病率和死亡率的一个不常见但不良的原因。围手术期使用β受体阻滞剂药物进行预防已被证明可降低非心脏手术患者的院内心脏死亡。本研究评估了遵循围手术期β受体阻滞剂预防机构方案的267例全膝关节置换术连续队列患者的安全性和院内心脏并发症。患者分为三组：A组，已在服用β受体阻滞剂；B组，由骨科医生开具β受体阻滞剂；C组，未给予该药物。评估了90天死亡率和院内心脏并发症。在接受267例手术的患者中，203例（76%）围手术期接受了β受体阻滞剂预防：110例（41.2%）术前已在服用该药物，93例（34.8%）由外科医生开具该药物，64例（24%）未接受该药物。前90天内无死亡病例。有2例非致命性心肌梗死（0.7%）和6例其他心脏并发症（2.2%）。由一名外科医生实施β受体阻滞剂预防方案后，76%的全膝关节置换术患者接受了该药物，其中34.8%由骨科医生开具。院内心脏并发症发生率较低。
