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JAMA Inter Med:研究质疑心脏搭桥手术前使用β受体阻滞剂的作用

2014-06-17 何Jason 医学专业新闻

一项最新研究指出,尽管术前给予β受体阻滞剂是常规做法,但对于接受择期心脏搭桥手术的患者而言,术前一天给予β受体阻滞剂可能并无改善转归的作用。 研究作者说,实际上搭桥手术前24小时如果给予β受体阻滞剂,甚至可能与心房颤动风险轻微上升有关。该药物常用于减缓心跳以降低血压。 该研究的主要作者,来自达拉斯心肺病研究和技术中心的Dr. William Brinkman说:“在某些特定的前提下,β受体阻滞

一项最新研究指出,尽管术前给予β受体阻滞剂是常规做法,但对于接受择期心脏搭桥手术的患者而言,术前一天给予β受体阻滞剂可能并无改善转归的作用。

研究作者说,实际上搭桥手术前24小时如果给予β受体阻滞剂,甚至可能与心房颤动风险轻微上升有关。该药物常用于减缓心跳以降低血压。

该研究的主要作者,来自达拉斯心肺病研究和技术中心的Dr. William Brinkman说:“在某些特定的前提下,β受体阻滞剂对临床患者是有益的。但这些药物并未改善搭桥手术患者的转归。”

该研究在线发表在6月16日的JAMA Internal Medicine。

但有心脏病专科医生指出,该研究并未证实β受体阻滞剂与不良事件有关。因此,搭桥手术前仍有必要常规给予β受体阻滞剂,直至有进一步的研究明确其负面影响。

在这项研究中,Brinkman及其团队利用心胸外科学会的National Adult Cardiac数据库,对2008年至2012年间共计506,000名患者的病例记录进行了回顾。这些患者均接受了非紧急心脏搭桥手术,且术前21天并未发生心肌梗塞或任何高危症状。

然而,β受体阻滞剂与房颤风险轻微增加有关。房颤是一种潜在的致死性心律失常。他们发现,服用β受体阻滞剂的患者中有21.5%出现房颤,未服药的患者则为20.1%。

由于研究并未证实β受体阻滞剂对转归的改善作用,Brinkman并不认为搭桥手术术前常规给予β受体阻滞剂是理所当然的事。但对于医生和医院而言,术前是否常规给予β受体阻滞剂乃“医疗质量评定”的标准。

Brinkman说:“这项研究对所谓的医疗质量指标提出质疑。我们并不是说β受体阻滞剂有害,但这些药物只能在某些特定的前提下使用。容易测量的指标不等于是好的质量指标。”

Dr. David Shahian是波士顿麻省总医院的医疗质量和安全中心的副主任,同期发表了一篇相关评论。他指出,这项研究的结果是有趣的,值得进一步探究。但大部分类似的研究却得出相反的结论。

Shahian说,其它研究均证实搭桥手术术前的β受体阻滞剂有助降低房颤风险,包括术前、术中和术后的风险。而房颤可能导致脑卒中等影响长期生存的疾病。

他说:“这项研究并未考虑不同种类的特异性β受体阻滞剂、药物剂量和治疗启动时间等问题。这些因素均可影响最终结论。”

Shahian说,在相关问题得到最终确定前,临床医生应继续遵循指南建议并在搭桥手术术前给予β受体阻滞剂,在考虑个体因素的前提下进行合适的治疗。

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    2015-05-23 saikp
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  5. [GetPortalCommentsPageByObjectIdResponse(id=1995111, encodeId=61f71995111b8, content=<a href='/topic/show?id=347538040cf' target=_blank style='color:#2F92EE;'>#受体阻滞剂#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=45, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=38040, encryptionId=347538040cf, topicName=受体阻滞剂)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=54f9127, createdName=tulenzi, createdTime=Sun Mar 08 05:27:00 CST 2015, time=2015-03-08, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1663884, encodeId=6d5c1663884f6, content=<a href='/topic/show?id=03a35691e2e' target=_blank style='color:#2F92EE;'>#搭桥#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=71, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=56917, encryptionId=03a35691e2e, topicName=搭桥)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=557f25711234, createdName=12498b3em16(暂无昵称), createdTime=Wed May 27 12:27:00 CST 2015, time=2015-05-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1735045, encodeId=20e71e350455e, content=<a href='/topic/show?id=9aa5923e176' target=_blank style='color:#2F92EE;'>#质疑#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=52, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=92371, encryptionId=9aa5923e176, topicName=质疑)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=2d3033872914, createdName=saikp, createdTime=Sat May 23 04:27:00 CST 2015, time=2015-05-23, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1694780, encodeId=00a01694e807e, content=<a href='/topic/show?id=030551528ec' target=_blank style='color:#2F92EE;'>#心脏搭桥#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=63, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=51528, encryptionId=030551528ec, topicName=心脏搭桥)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=5ba429754956, createdName=grace5710, createdTime=Sun Aug 03 23:27:00 CST 2014, time=2014-08-03, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2085703, encodeId=37862085e03da, content=<a href='/topic/show?id=723a9e69383' target=_blank style='color:#2F92EE;'>#阻滞剂#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=45, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=97693, encryptionId=723a9e69383, topicName=阻滞剂)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=40be178, createdName=zhyy88, createdTime=Fri Dec 19 18:27:00 CST 2014, time=2014-12-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1274924, encodeId=df3c12e492421, content=<a href='/topic/show?id=338c19228b0' target=_blank style='color:#2F92EE;'>#β受体阻滞剂#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=61, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=19228, encryptionId=338c19228b0, topicName=β受体阻滞剂)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=685a124, createdName=muzishouyi, createdTime=Thu Jun 19 07:27:00 CST 2014, time=2014-06-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1606210, encodeId=b59f1606210a2, content=<a href='/topic/show?id=eb6b1145939' target=_blank style='color:#2F92EE;'>#Med#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=52, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=11459, encryptionId=eb6b1145939, topicName=Med)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=552a19396740, createdName=ms3994565386320060, createdTime=Thu Jun 19 07:27:00 CST 2014, time=2014-06-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1623518, encodeId=8d3f162351899, content=<a href='/topic/show?id=37de5691841' target=_blank style='color:#2F92EE;'>#搭桥手术#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=72, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=56918, encryptionId=37de5691841, topicName=搭桥手术)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f7c320527759, createdName=stfoxst, createdTime=Thu Jun 19 07:27:00 CST 2014, time=2014-06-19, status=1, ipAttribution=)]
    2014-12-19 zhyy88
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