阻滞药在围手术期的应用.pptxVIP

??-阻滞药治疗高危血管外科的疗效Effect of β-blockor in treating high risk vascular surgery N Engl J Med 1999;341:1789-94标准治疗+β受体阻滞剂Standard Therapy+β-blocker 标准治疗组Standard TherapyP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%0.001致死性心梗 (Fatal Myocardial Infarction)0.0%17%0.001美国?-阻滞药治疗急性心梗回顾性研究Retrospective study of β-blocker ‘s therapy in acute myocardial infarction in USA Archives of Internal Medicine 2000, 160:947CABG: 8,482例 ；PTCA: 13,997例一年死亡率统计 (one-year mortality rate)( P0.001 ) ：β－阻滞剂治疗 (group withβ-blocker therapy) ：12.3% 未β－阻滞剂治疗 (group without β-blocker therapy)： 23.6%冠脉血管重建:β阻滞剂能明显降低一年死亡率; CABG: β-blocker therapy significantly decrease one-year mortalityβ－阻滞药围术期心脏的保护作用Heart protective effect of β-blockor in perioperative period 北京阜外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 The department of anaethesia of our hospital has tried using β-blockor to treat cardiac events since 1990’s and its results challenged the traditional concept of treating these events.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Metoprolol has been becoming a drug in common use in treating cardiac events in perioperative period since 1995.96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-blockor began to be a drug using preoperatively after June 1996. Nowadays, it is administrated broadly before big cardiac operations.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-blockor has become a main drug in treating unsuccessful resuscitation except the general treatments.病例(case)体外循环下冠脉搭桥 (CABG under cardiopulmonary bypass) 术前病情偏重，EF约40％， 未放置漂浮导管; Relatively severe condition before operation, EF about 40%,pulmonary artery catheter unlocated;停机时给予0.03ug/kg/min肾上腺素辅助循环; 0.03ug/kg/min epinephrine to support circulation stability after stopping cardiopulmonary bypass;静注鱼精蛋白循环尚稳定; Hemadynamic stability during protamine intravenous administration;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; Blood pressure decreased 5 minutes after portamine administration ，elevated after