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BJA:β-受体阻滞剂对腹主动脉瘤病人体能的影响

2015-07-08 嗷大森 MedSci原创

β-受体阻滞剂是能选择性地与β肾上腺素能受体结合,从而拮抗神经递质和儿茶酚胺对β-受体激动作用的一种药物类型,具有减慢心率、减弱心肌收缩力、降低血压、防止儿茶酚胺对心脏损害的作用。 在围手术期,尤其是血管外科手术前被广泛使用;心肺功能运动试验可在负荷递增的运动中反映人体的心肺功能,经过对各项参数的综合分析,了解心脏、肺脏和循环系统之间的相互作用与贮备能力。然而,通过心肺功能运动试验来评估

本文亮点:

•这项研究探讨了短期及长期服用β-受体阻滞剂对血管外科病人在  心肺功能运动试验中表现的影响

•长期服用β-受体阻滞剂的病人摄氧量更低

•首次服用或停用β-受体阻滞剂对摄氧量无影响

•心肺功能运动试验的一些其他测量指标出现具有统计学意义的适度改善

•临床医生需要考虑β-受体阻滞剂对老年血管外科病人在心肺功能运动试验中表现的影响


β-受体阻滞剂是能选择性地与β肾上腺素能受体结合,从而拮抗神经递质和儿茶酚胺对β-受体激动作用的一种药物类型,具有减慢心率、减弱心肌收缩力、降低血压、防止儿茶酚胺对心脏损害的作用。

在围手术期,尤其是血管外科手术前被广泛使用;心肺功能运动试验可在负荷递增的运动中反映人体的心肺功能,经过对各项参数的综合分析,了解心脏、肺脏和循环系统之间的相互作用与贮备能力。然而,通过心肺功能运动试验来评估β-受体阻滞剂对腹主动脉瘤病人体能的影响尚不清楚。我们猜测给予β-受体阻滞剂后,可以显著提高心肺功能运动试验中腹主动脉瘤病人的体能。

方法:


图 1 CONSORT 图表——心肺功能运动试验(CPET)

这是一项单盲干预研究。我们招募了通过临床监测动脉瘤直径小于5.5厘米的腹主动脉瘤病人作为本次研究的试验对象。所有病人无论是否服用β-受体阻滞剂,均需进行心肺功能运动试验。常规给予β-受体阻滞剂的病人在治疗过程中进行第一次心肺功能运动试验,病人停止使用β-受体阻滞剂一周后进行第二次心肺功能运动试验。

未常规服用β-受体阻滞剂的病人在治疗前进行第一次心肺功能运动试验,在开始服用高选择性β1-肾上腺素能受体拮抗剂比索洛尔至少48小时后进行第二次心肺功能运动试验。达到预计乳酸阈值时的摄氧量及最大摄氧量是主要的结果变量。采用线性混合效应模型将服用和未服用β-受体阻滞剂的两组患者的心肺功能运动试验变量差异标准化。

结果:

48位腹主动脉瘤病人完成了该项研究。在达到预计乳酸阈值时的摄氧量和最大摄氧量间未发现差异,然而,在达到预计乳酸阈值及最大耗氧量时的VE/VCO2显著降低,服用β-受体阻滞剂的病人在达到预计乳酸阈值及最大摄氧量时均发现乳酸阈值,每博氧耗量和心率的增加,常规服用β-受体阻滞剂的病人(慢性组)的体能更差(摄氧量更低)



结论:

尽管β-受体阻滞剂没有改变达到预计乳酸阈值时的摄氧量及最大摄氧量,其对心肺功能运动试验中腹主动脉瘤病人的体能有显著影响。腹主动脉瘤病人在围术期进行适当的体育锻炼,不管是否使用β-受体阻滞剂都可以提高其在心肺功能运动试验中的表现。


原始出处:

West MA1, Parry M2, Asher R3, Key A2, Walker P4, Loughney L5, Pintus S6, Duffy N2, Jack S7, Torella F8.The Effect of beta-blockade on objectively measured physical fitness in patients with abdominal aortic aneurysms - A blinded interventional study.Br J Anaesth. 2015 Jun;114(6):878-85. doi: 10.1093/bja/aev026. Epub 2015 Feb 24.

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    2015-09-11 liubm568
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    2016-04-15 zhyy88
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    2015-07-09 owlhealth

    这哈不错

    0

  8. [GetPortalCommentsPageByObjectIdResponse(id=1770492, encodeId=d48b1e70492bb, content=<a href='/topic/show?id=05fe2665508' target=_blank style='color:#2F92EE;'>#体能#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=72, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=26655, encryptionId=05fe2665508, topicName=体能)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=80ae38174281, createdName=liubm568, createdTime=Fri Sep 11 05:38:00 CST 2015, time=2015-09-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1995116, encodeId=d5261995116d0, 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=71, 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=Sat Jan 09 00:38:00 CST 2016, time=2016-01-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2085712, encodeId=f2ad2085e122c, 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=52, 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 Apr 15 02:38:00 CST 2016, time=2016-04-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1415003, encodeId=2c9114150030c, content=<a href='/topic/show?id=04812314540' target=_blank style='color:#2F92EE;'>#主动脉#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=58, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=23145, encryptionId=04812314540, topicName=主动脉)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=77603112682, createdName=circumcision, createdTime=Fri Jul 10 07:38:00 CST 2015, time=2015-07-10, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1428992, encodeId=3cbc1428992ff, content=<a href='/topic/show?id=ee192321560' target=_blank style='color:#2F92EE;'>#主动脉瘤#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=70, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=23215, encryptionId=ee192321560, topicName=主动脉瘤)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=95e34160730, createdName=fengting4, createdTime=Fri Jul 10 07:38:00 CST 2015, time=2015-07-10, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1548146, encodeId=12c51548146fb, content=<a href='/topic/show?id=6ebe1918eb0' target=_blank style='color:#2F92EE;'>#β-受体阻滞剂#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=56, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=19187, encryptionId=6ebe1918eb0, topicName=β-受体阻滞剂)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=ae5b14012389, createdName=12498e87m43暂无昵称, createdTime=Fri Jul 10 07:38:00 CST 2015, time=2015-07-10, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=32022, encodeId=e7cc32022c7, content=这哈不错, beContent=null, objectType=article, channel=null, level=null, likeNumber=141, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=3b2c1627329, createdName=owlhealth, createdTime=Thu Jul 09 16:15:00 CST 2015, time=2015-07-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=31932, encodeId=3a7d3193247, content=看看, beContent=null, objectType=article, channel=null, level=null, likeNumber=130, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=ee0d1618732, createdName=huaxipanxing, createdTime=Thu Jul 09 13:39:00 CST 2015, time=2015-07-09, status=1, ipAttribution=)]
    2015-07-09 huaxipanxing

    看看

    0

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