课件：a-分析在临床麻醉中的应用.ppt

* * * * * Poldermans et al examined the effect of bisoprolol on patients at high risk for perioperative cardiac complications. Of 846 patients with risk factors for cardiac disease and scheduled for vascular surgery, 173 were found to have an abnormal dobutamine stress echocardiogram (DSE). Of these patients, 61 were excluded from further study owing to marked abnormalities on DSE or because they were already taking beta blockers. The remaining 112 patients were randomized to bisoprolol or placebo perioperatively. The rates of cardiac death (3.4% vs. 17%; p=0.02) and nonfatal MI (0% vs. 17%; p less than 0.001) were lower for the bisoprolol vs. placebo groups, respectively. Generalizability of this study is limited by the unblinded design and the exclusion of all but the highest-risk patients. Also, patients began taking bisoprolol a mean of 37 days before surgery, with adjustments made based on heart rate. * Background Perioperative myocardial ischemia is the single most important potentially reversible risk factor for mortality and cardiovascular complications after noncardiac surgery. Although more than 1 million patients have such complications annually, there is no effective preventive therapy. Methods We performed a randomized, doubleblind, placebo-controlled trial to compare the effect of atenolol with that of a placebo on overall survival and cardiovascular morbidity in patients with or at risk for coronary artery disease who were undergoing noncardiac surgery. Atenolol was given intravenously before and immediately after surgery and orally thereafter for the duration of hospitalization. Patients were followed over the subsequent two years. * Results A total of 200 patients were enrolled. Ninety-nine were assigned to the atenolol group, and 101 to the placebo group. One hundred ninety-four patients survived to be discharged from the hospital, and 192 of these were followed for two years. Overall mortality after discharge from the hospital was significantly l