β-Blockade and Operative Mortality in Noncardiac Surgery: Harmful or Helpful?
β-Blockade and Operative Mortality in Noncardiac Surgery: Harmful or Helpful?
复制标题
β-阻断和非心脏手术中的手术死亡率：有害还是有益？
DOI：
10.1001/jamasurg.2015.86
复制
发表时间：
2015
期刊：
影响因子：
16.9
通讯作者：
P. Almenoff
中科院分区：
文献类型：
--
作者：
M. Friedell;C. V. Van Way;R. Freyberg;P. Almenoff
重要性
由于卒中和低血压的风险，在接受非心脏手术（NCS）的心肌缺血事件低风险患者中使用围手术期药物β-阻滞剂存在争议。已发表的研究未发现该队列的一致获益。
目的
确定围手术期β受体阻滞剂对接受NCS的患者的影响，特别是那些没有危险因素的患者。
设计、设置和参与者
这是一项对2008年10月1日至2013年9月31日在退伍军人事务部医院接受手术的患者进行的回顾性观察分析。
方法
如果在术前8小时至术后24小时之间的任何时间订购了剂量，则确定β受体阻滞剂的使用。来自退伍军人事务部电子数据库的数据包括人口统计学、诊断和程序代码、药物、围手术期实验室值和死亡日期。通过为肾衰竭、冠状动脉疾病、糖尿病和主要体腔手术各分配1分来计算4分心脏风险评分。使用先前验证的所有住院急性护理内科或外科患者的线性回归模型计算预测死亡率，然后计算比值比（OR）。
主要结果和措施
终点为30天手术死亡率。
结果
该队列中有326，489例患者：314，114例接受NCS，12，375例接受心脏手术。β受体阻滞剂显著降低了具有3 - 4个心脏风险因素的NCS患者的死亡率OR（OR，0.63; 95% CI，0.43-0.93）。对有1 ~ 2个危险因素的患者无影响。然而，β-受体阻滞剂导致无风险因素的NCS患者的死亡率显著升高（OR，1.19; 95% CI，1.06-1.35）。
结论和相关性
在这一大型系列研究中，β受体阻滞剂似乎对接受NCS的高心脏风险患者的围手术期有益。然而，在接受NCS的无心脏风险因素的患者中使用β受体阻滞剂增加了该患者队列的死亡风险。
IMPORTANCE
The use of perioperative pharmacologic β-blockade in patients at low risk of myocardial ischemic events undergoing noncardiac surgery (NCS) is controversial because of the risk of stroke and hypotension. Published studies have not found a consistent benefit in this cohort.
OBJECTIVE
To determine the effect of perioperative β-blockade on patients undergoing NCS, particularly those with no risk factors.
DESIGN, SETTING, AND PARTICIPANTS
This is a retrospective observational analysis of patients undergoing surgery in Veterans Affairs hospitals from October 1, 2008, through September 31, 2013.
METHODS
β-Blocker use was determined if a dose was ordered at any time between 8 hours before surgery and 24 hours postoperatively. Data from the Veterans Affairs electronic database included demographics, diagnosis and procedural codes, medications, perioperative laboratory values, and date of death. A 4-point cardiac risk score was calculated by assigning 1 point each for renal failure, coronary artery disease, diabetes mellitus, and surgery in a major body cavity. Previously validated linear regression models for all hospitalized acute care medical or surgical patients were used to calculate predicted mortality and then to calculate odds ratios (ORs).
MAIN OUTCOMES AND MEASURES
The end point was 30-day surgical mortality.
RESULTS
There were 326,489 patients in this cohort: 314,114 underwent NCS and 12,375 underwent cardiac surgery. β-Blockade lowered the OR for mortality significantly in patients with 3 to 4 cardiac risk factors undergoing NCS (OR, 0.63; 95% CI, 0.43-0.93). It had no effect on patients with 1 to 2 risk factors. However, β-blockade resulted in a significantly higher chance of death in patients (OR, 1.19; 95% CI, 1.06-1.35) with no risk factors undergoing NCS.
CONCLUSIONS AND RELEVANCE
In this large series, β-blockade appears to be beneficial perioperatively in patients with high cardiac risk undergoing NCS. However, the use of β-blockers in patients with no cardiac risk factors undergoing NCS increased risk of death in this patient cohort.
影响因子：
9.6
作者：
KNAUS, WA;WAGNER, DP;HARRELL, FE
通讯作者：
HARRELL, FE
影响因子：
37.8
作者：
Lee, TH;Marcantonio, ER;Goldman, L
通讯作者：
Goldman, L