β阻滞药在围手术期的应用

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1、β阻滞药在围手术期的应用PerioperativeApplicationofβ-AdrenergicReceptorBlocker李立环LiLihuan北京阜外心血管病医院FuWaiHospital(Beijing)-阻滞药治疗高危血管外科的疗效Effectofβ-blockorintreatinghighriskvascularsurgery标准治疗+β受体阻滞剂StandardTherapy+β-blocker标准治疗组StandardTherapyP值PValue心血管死亡(CardiovascularDeath)3.4%17%=0

2、.02非致死性心梗(NonfatalMyocardialInfarction)0.0%17%<0.001致死性心梗(FatalMyocardialInfarction)0.0%17%<0.001NEnglJMed1999;341:1789-94ArchivesofInternalMedicine2000,160:947美国-阻滞药治疗急性心梗回顾性研究Retrospectivestudyofβ-blocker‘stherapyinacutemyocardialinfarctioninUSACABG:8,482例；PTCA:13,997例一年死

3、亡率统计(one-yearmortalityrate)(P<0.001)：β－阻滞剂治疗(groupwithβ-blockertherapy)：12.3%未β－阻滞剂治疗(groupwithoutβ-blockertherapy)：23.6%冠脉血管重建:β阻滞剂能明显降低一年死亡率;CABG:β-blockertherapysignificantlydecreaseone-yearmortalityβ－阻滞药围术期心脏的保护作用Heartprotectiveeffectofβ-blockorinperioperativeperiod北京阜外

4、心血管病医院麻醉科从90年起术中尝试使用β－阻药处理心脏事件，取得的效果挑战了对心脏事件处理的传统观念Thedepartmentofanaethesiaofourhospitalhastriedusingβ-blockortotreatcardiaceventssince1990’sanditsresultschallengedthetraditionalconceptoftreatingtheseevents.95年开始美托洛尔渐渐成为CABG围术期处理心脏事件的常用药物Metoprololhasbeenbecomingadrugincomm

5、onuseintreatingcardiaceventsinperioperativeperiodsince1995.96年6月后，β－阻滞药开始作为冠心病术前用药。现已在某些瓣膜病、先心病、大动脉瘤术前用药中广泛应用β-blockorbegantobeadrugusingpreoperativelyafterJune1996.Nowadays,itisadministratedbroadlybeforebigcardiacoperations.β阻滞药已成为心脏手术中困难复苏非常规处理的主要药物β-blockorhasbecomeamaind

6、rugintreatingunsuccessfulresuscitationexceptthegeneraltreatments.病例(case)体外循环下冠脉搭桥(CABGundercardiopulmonarybypass)术前病情偏重，EF约40％，未放置漂浮导管;Relativelysevereconditionbeforeoperation,EFabout40%,pulmonaryarterycatheterunlocated;停机时给予0.03ug/kg/min肾上腺素辅助循环;0.03ug/kg/minepinephrinetos

7、upportcirculationstabilityafterstoppingcardiopulmonarybypass;静注鱼精蛋白循环尚稳定;Hemadynamicstabilityduringprotamineintravenousadministration;鱼精蛋白注毕后约5min血压下降，加大肾上腺素用量血压上升;Bloodpressuredecreased5minutesafterportamineadministration，elevatedafterincreasingdoseofepinephrine;数分钟后出现下列临床征

8、象Followingsymptomsoccurredfewminuteslater临床症状(clinicalsymptoms)急性肺水肿，粉红色泡沫样