The experts debate: perioperative beta-blockade for noncardiac surgery--proven safe or not?
The experts debate: perioperative beta-blockade for noncardiac surgery--proven safe or not?
复制标题
DOI：
10.3949/ccjm.76.s4.14
复制
发表时间：
2009-11-01
影响因子：
6.1
通讯作者：
Devereaux, P J
中科院分区：
文献类型：
--
作者：
Poldermans, Don;Devereaux, P J
接受非心脏手术患者的围手术期管理指南建议在尚未服用β受体阻滞剂的高危患者中预防性使用围手术期β受体阻滞剂，并在手术前持续使用β受体阻滞剂的患者中继续使用。这些建议最近受到了围手术期缺血评价（POISE）结果的挑战，POISE是一项在动脉粥样硬化疾病高危患者非心脏手术前立即开始的琥珀酸美托洛尔缓释剂的大型随机试验。在POISE中，美托洛尔相对于安慰剂显著减少心肌梗死，但它也与卒中和死亡率显著增加相关。POISE的优点和局限性及其在围手术期β-受体阻滞剂的其他试验中的适用性在此由该领域的两位专家Don Poldermans博士和P. J. Devereaux博士（POISE的共同首席研究员）进行辩论。
Guidelines on perioperative management of patients undergoing noncardiac surgery recommend the use of prophylactic perioperative beta-blockers in high-risk patients who are not already taking them, and their continuance in patients on chronic beta-blockade prior to surgery. These recommendations were challenged recently by results of the Perioperative Ischemic Evaluation (POISE), a large randomized trial of extended-release metoprolol succinate started immediately before noncardiac surgery in patients at high risk for atherosclerotic disease. While metoprolol significantly reduced myocardial infarctions relative to placebo in POISE, it also was associated with significant excesses of both stroke and mortality. The merits and limitations of POISE and its applicability in light of other trials of perioperative beta-blockade are debated here by two experts in the field-Dr. Don Poldermans and Dr. P. J. Devereaux (co-principal investigator of POISE).