Perioperative metoprolol reduces the frequency of atrial fibrillation after thoracotomy for lung resection
Perioperative metoprolol reduces the frequency of atrial fibrillation after thoracotomy for lung resection
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DOI：
10.1016/s1053-0770(97)90169-5
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发表时间：
1997-10-01
影响因子：
2.8
通讯作者：
Andresen, EB
中科院分区：
文献类型：
--
作者：
Jakobsen, CJ;Bille, S;Andresen, EB
目的：心房颤动与胸外科手术的关系是众所周知的，但其原因尚不明确。交感神经活动的增加可能在房颤的发展中起作用，而β受体活动的减少可能是有利的。目的是评估口服-阻滞剂对房颤频率的影响，并评估一些可能的致病因素。设计和环境：该研究是前瞻性、随机、双盲的，在奥胡斯大学医院进行。参与者：30例无心血管病史的择期开胸肺切除术患者。干预措施：患者术前口服100mg美托洛尔或安慰剂，术后每日一次，麻醉包括胸段硬膜外阻滞联合全身静脉麻醉。术后继续使用硬膜外吗啡。测量方法及主要结果：监测患者心电图、毛细血管脉搏血氧仪、有创血流动力学监测、中心静脉血氧饱和度、动脉血气、血清电解质、体液平衡。23.3%的患者发生房颤，美托洛尔组为6.7%，而安慰剂组为40%，术后平均2.9天发生房颤。主要的血流动力学表现为美托洛尔后围手术期较低的耗氧量和术后较低的心脏指数。心房颤动患者的耗氧量和术后心脏指数明显高于其他患者。结论：围手术期口服β -阻滞剂可降低房颤发生频率，且无严重副作用。交感神经活动增加是引起这种并发症的主要因素之一。版权所有：W.B. Saunders Company。
Objective: The association of atrial fibrillation with thoracic surgical procedures is well known, but nevertheless its cause is not well defined. Increased sympathetic activity may play a role in the development of atrial fibrillation, and reduced beta-receptor activity may be advantageous. The objective was to evaluate the effect of oral beta-blockade on the frequency of atrial fibrillation and to evaluate some possible causative factors.Design and Setting: The study was prospective, randomized, and double-blind, and was conducted at Aarhus University Hospital.Participants: Thirty patients without previous or present cardiovascular history undergoing elective thoracotomy for lung resection.Interventions: The patients received either 100 mg of metoprolol or placebo orally before surgery and once daily postoperatively, Anesthesia consisted of a thoracic epidural block combined with general intravenous anesthesia. Epidural morphine was continued postoperatively.Measurements and Main Results: Patients were monitored with electrocardiograms (ECGs), capillary pulse oximetry, invasive hemodynamic monitoring, central Venous oxygen saturation, arterial blood gases, serum electrolytes, and fluid balances. Atrial fibrillation developed in 23.3% of the patients, 6.7% after metoprolol compared with 40% in the placebo group, Atrial fibrillation developed a mean of 2.9 days postoperatively. The predominant hemodynamic findings were perioperative lower oxygen consumption and postoperative lower cardiac index after metoprolol. Patients developing atrial fibrillation had much higher oxygen consumption and postoperative cardiac index than other patients.Conclusion: Perioperative oral beta-blockade can reduce the frequency of atrial fibrillation without serious side effects. Increased sympathetic activity is one of the predominant factors in the cause of this complication. Copyrights (C) 1997 by W.B. Saunders Company.