Zhao Bing-Cheng, Huang Tong-Yi, Deng Qi-Wen, Liu Wei-Feng, Liu Jian, Deng Wen-Tao, Liu Ke-Xuan, Li Cai
Department of Anesthesiology, Nanfang Hospital, Southern Medical University, Guangzhou, China; Department of Anesthesiology, the First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China.
Department of Ultrasonography, the First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China.
Chest. 2017 Jan;151(1):149-159. doi: 10.1016/j.chest.2016.08.1476. Epub 2016 Oct 8.
Postoperative atrial fibrillation/flutter (POAF) is associated with significant morbidity and mortality after general thoracic surgery, but the need for and the best agent for prophylaxis remains obscure.
A systematic literature search was performed to identify randomized controlled trials that compared regimens for POAF prophylaxis after general thoracic surgery. Random-effects meta-analyses with trial sequential analyses were performed to compare the effects of medical prophylaxis vs placebo/usual care. The risk of POAF among patients receiving various prophylactic regimens was subjected to Bayesian network meta-analysis.
Twenty-two trials (2,891 patients and 11 regimens) were included. Overall, medical prophylaxis reduced the incidence of POAF (OR, 0.33; 95% CI, 0.22-0.49) but not short-term mortality (OR, 0.85; 95% CI, 0.41-1.73). There was no significant difference in patient withdrawal due to adverse events (OR, 1.67; 95% CI, 0.67-4.16). Trial sequential analysis showed that as of 2012, sufficient evidence had accrued in support of the effectiveness of medical prophylaxis in reducing POAF after general thoracic surgery. In network meta-analysis, β-blockers, angiotensin-converting enzyme inhibitors, amiodarone, magnesium, and calcium channel blockers significantly reduced the risk of POAF compared with placebo/usual care. β-Blockers had the highest probability of being the most effective agents (OR, 0.12; 95% credible interval [CrI], 0.05-0.27; probability of being best, 77.7%; number needed to treat, 5.2).
The current literature supports the effectiveness and tolerability of medical prophylaxis and the superiority of β-blockers in preventing POAF after general thoracic surgery. β-Blockers are recommended, taking into consideration the status of the bronchopulmonary system.
术后心房颤动/扑动（POAF）与普通胸外科手术后的显著发病率和死亡率相关，但预防的必要性和最佳药物仍不明确。
进行系统的文献检索，以确定比较普通胸外科手术后POAF预防方案的随机对照试验。采用随机效应荟萃分析和试验序贯分析来比较药物预防与安慰剂/常规治疗的效果。对接受各种预防方案的患者发生POAF的风险进行贝叶斯网络荟萃分析。
纳入22项试验（2891例患者和11种方案）。总体而言，药物预防降低了POAF的发生率（OR，0.33；95%CI，0.22 - 0.49），但未降低短期死亡率（OR，0.85；95%CI，0.41 - 1.73）。因不良事件导致的患者退出率无显著差异（OR，1.67；95%CI，0.67 - 4.16）。试验序贯分析表明，截至2012年，已有足够证据支持药物预防在降低普通胸外科手术后POAF方面的有效性。在网络荟萃分析中，与安慰剂/常规治疗相比，β受体阻滞剂、血管紧张素转换酶抑制剂、胺碘酮、镁和钙通道阻滞剂显著降低了POAF的风险。β受体阻滞剂成为最有效药物的概率最高（OR，0.12；95%可信区间[CrI]，0.05 - 0.27；最佳概率，77.7%；需治疗人数，5.2）。
当前文献支持药物预防的有效性和耐受性以及β受体阻滞剂在预防普通胸外科手术后POAF方面的优越性。考虑到支气管肺系统状况，推荐使用β受体阻滞剂。
