术中静脉输注美托洛尔对心脏病患者非心脏手术后心脏并发症的影响  

Effects of metoprolol infusion during operation on cardiac complications in patients with heart disease after noncardlac surgery

作　　者：乔飞[1] 曾焱[2] 张毅[1] 吴洪翔[1] 

机构地区：[1]昆明医学院第一附属医院麻醉科,650032 [2]昆明市儿童医院麻醉科

出　　处：《中华麻醉学杂志》2009年第5期435-438,共4页Chinese Journal of Anesthesiology

摘　　要：目的评价术中静脉输注美托洛尔对心脏病患者非心脏手术后心脏并发症的影响。方法拟行胸部手术或腹部手术的心脏病患者87例，年龄55—78岁，随机分为对照组（n=42）和试验组（=45）。试验组切皮前5min静脉注射美托洛尔20μg/kg负荷量，随后以0．1—1．0μg·kg^-1·min^-1速率静脉输注至术毕，控制HR较术前降低15％-20％，但维持HR≥60次／min、平均动脉压≥60mmHg。分别于术前24h内（术前）及术后24h内（术后）持续监测心电图，记录平均．HR、早搏次数、异位心律失常及心肌缺血的发生情况；记录术后7d内心脏事件的发生情况。结果与术前比较，术后对照组平均HR增快（P〈0．05），而试验组差异无统计学意义（P〈0．05）；与对照组比较，术后试验组早搏次数、异位心律失常发生率和心肌缺血发生率降低（P〈0．05），术后心脏事件发生率差异无统计学意义（P〈0．05）。结论术中静脉输注美托洛尔（静脉注射负荷量20μg／kg后以0．1—1．0μg·kg^-1·min^-1的速率静脉输注）可降低心脏病患者非心脏手术后心脏并发症的发生。Objective To investigate the effects of metoprolol infusion during operation on cardiac complications in patients with heart disease after noncardiac surgery. Methods Eighty-seven patients with heart disease, aged 55-78 yr, scheduled for thoracic or abdominal surgery, were randomly divided into control group （n = 42） and test group （n = 45）. Test group was injected intravenously a loading dose of metoprolol 20 tLg/kg, followed by iv infusion at a rate of 0.1-1.0 μg· kg^-1 ·min^-1 until the end of operation. HR was controlled and decreased by 15%-20% compared with that before operation, but it was maintained ≥ 60 bpm and MAP ≥ 60 mm Hg. ECG was continuously monitored and mean HR, frequency of premature beats, ectopic arrhythmia （including supraventricular tachycardia or ventricular tachycardia） and myocardial ischemia were recorded within 24 h before and after operation. The cardiac events within 7 d after operation were also recorded. Results Mean HR was significantly faster after operation than before operation in control group （ P 〈 0.05 ）, while there was no significant difference in mean HR before and after operation in test group （P 〉 0.05）. The frequency of premature beats, incidence of ectopic arrhythmia and myocardial ischemia were significantly lower after operation in test group than in control group （ P 〈 0.05）, while there was no significant difference in the incidence of cardiac events after operation between the two groups （ P 〉 0.05）. Conclusion Metoprolol infusion during operation can reduce the occurrence of cardiac complications in patients with heart disease after noncardiac surgery.

关 键 词：美托洛尔 心脏病 手术后并发症 心脏 

分 类 号：R614[医药卫生—麻醉学]