围手术期使用兰地洛尔可降低心脏手术后房颤的发生率：一项随机对照试验的荟萃分析。
Perioperative landiolol administration reduces atrial fibrillation after cardiac surgery: A meta-analysis of randomized controlled trials.
作者信息
Sakamoto Atsuhiro, Hamasaki Toshimitsu, Kitakaze Masafumi
机构信息
Department of Anesthesiology and Pain Medicine, Graduate School of Medicine, Nippon Medical School, Tokyo, 113-8603, Japan,
出版信息
Adv Ther. 2014 Apr;31(4):440-50. doi: 10.1007/s12325-014-0116-x. Epub 2014 Apr 23.
INTRODUCTION
Postoperative atrial fibrillation (POAF) is one of the most common complications after cardiac surgery. Patients who develop POAF have a prolonged stay in the intensive care unit and hospital and an increased risk of postoperative stroke. Many guidelines for the management of cardiac surgery patients, therefore, recommend perioperative administration of beta-blockers to prevent and treat POAF. Landiolol is an ultra-short acting beta-blocker, and some randomized controlled trials of landiolol administration for the prevention of POAF have been conducted in Japan. This meta-analysis evaluated the effectiveness of landiolol administration for the prevention of POAF after cardiac surgery.
METHODS
The Medline/PubMed and BioMed Central databases were searched for randomized controlled trials comparing cardiac surgery patients who received perioperative landiolol with a control group (saline administration, no drug administration, or other treatment). Two independent reviewers selected the studies for inclusion. Data regarding POAF and safety outcomes were extracted. Odds ratios (ORs) with 95% confidence intervals (CIs) were calculated using the Mantel-Haenszel method (fixed effects model).
RESULTS
Six trials with a total of 560 patients were included in the meta-analysis. Landiolol administration significantly reduced the incidence of POAF after cardiac surgery (OR 0.26, 95% CI 0.17-0.40). The effectiveness of landiolol administration was similar in three groups: all patients who underwent coronary artery bypass grafting (CABG) (OR 0.27, 95% CI 0.17-0.43), patients who underwent CABG compared with a control group who received saline or nothing (OR 0.28, 95% CI 0.17-0.45), and all patients who underwent cardiac surgery compared with a control group who received saline or nothing (OR 0.27, 95% CI 0.17-0.42). Only two adverse events associated with landiolol administration were observed (2/302, 0.7%): hypotension in one patient and asthma in one patient.
CONCLUSION
Landiolol administration reduces the incidence of POAF after cardiac surgery and is well tolerated.
引言
术后房颤（POAF）是心脏手术后最常见的并发症之一。发生POAF的患者在重症监护病房和医院的停留时间延长，术后中风风险增加。因此，许多心脏手术患者管理指南推荐围手术期使用β受体阻滞剂来预防和治疗POAF。兰地洛尔是一种超短效β受体阻滞剂，日本已经开展了一些关于使用兰地洛尔预防POAF的随机对照试验。本荟萃分析评估了使用兰地洛尔预防心脏手术后POAF的有效性。
方法
检索Medline/PubMed和BioMed Central数据库，查找比较围手术期接受兰地洛尔治疗的心脏手术患者与对照组（给予生理盐水、未用药或其他治疗）的随机对照试验。两名独立的评审员选择纳入研究。提取有关POAF和安全性结果的数据。使用Mantel-Haenszel方法（固定效应模型）计算95%置信区间（CI）的比值比（OR）。
结果
荟萃分析纳入了6项试验，共560例患者。使用兰地洛尔显著降低了心脏手术后POAF的发生率（OR 0.26，95%CI 0.17-0.40）。兰地洛尔在三组中的有效性相似：所有接受冠状动脉旁路移植术（CABG）的患者（OR 0.27，95%CI 0.17-0.43），接受CABG的患者与接受生理盐水或未接受任何治疗的对照组相比（OR 0.28，95%CI 0.17-0.45），以及所有接受心脏手术的患者与接受生理盐水或未接受任何治疗的对照组相比（OR 0.27，95%CI 0.17-0.42）。仅观察到2例与使用兰地洛尔相关的不良事件（2/302，0.7%）：1例患者出现低血压，1例患者出现哮喘。
结论
使用兰地洛尔可降低心脏手术后POAF的发生率，且耐受性良好。
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