阻滞药在围手术期的应用

阻滞药 在围手术期的应用 Perioperative Application of -Adrenergic Receptor Blocker 李立环 Li Lihuan 北京阜外心血管病医院 Fu Wai Hospital (Beijing) -阻滞药治疗高危血管外科的疗效 Effect of -blockor in treating high risk vascular surgery 标 准治 疗 + 受体阻滞 剂 Standard Therapy+ -blocker 标 准治 疗组 Standard Therapy P值 P Value 心血管死亡 (Cardiovascular Death) 3.4% 17% =0.02 非致死性心梗 (Nonfatal Myocardial Infarction) 0.0% 17% 240mg/dL(6.2mmol/L) (serum total cholesterol 240mg/dL) 5.有糖尿病但尚未需要胰岛素治疗者 (diabetes without receiving insulin therapy) 围术期使用 受体阻滞剂 结论 conclusion 1.围术期预防性使用 阻滞剂能减少心肌缺血、降低心 肌梗死发生率和总死亡率，冠心病患者和高危患者效 果尤其明显 Prophylactic using -blockor in perioperation period may reduce incidence rate of myocardial ischemia, decrease incidence rate and total mortality rate of myocardial infarction, especially in patients with CHD and in high risk patients. 2.择期手术的高危患者，术前应尽早 阻滞剂治疗 High risk patients ready to take selective operation should be given -blockor as early as possible before operation. 3.调整剂量使静息心率维持在 5060bpm（ 70bpm) Adjust the dose to maintain resting heart rate at 5060bpm（ less than 70bpm) 4.如有需要，应在麻醉诱导前静脉给药，控制心 率 If necessary, give intravenously before anaesthesia induction to control HR 5.手术后继续使用至少 7天（不能口服者应静脉 给药） Continue using for at least seven days after operation (intravenous administration to those unable to take orally) 6.冠心病只要没有禁忌证，应该无限期使用 阻 滞剂 In patients with CAD should be long-term used unless contraindication exists The Evidence Is In, Now the Work Begins ”Physicians can no longer accept the argument that absence of adequate knowledge is a reason for underuse of beta-blockers. The data are overwhelming and they have been published in leading medical journals.” Califf RM,