Perioperative beta-blockade to prevent cardiac morbidity in high-risk patients undergoing surgery (The POISE Study)

围手术期 β 受体阻滞剂可预防接受手术的高危患者的心脏病发病率（POISE 研究）

• 批准号: nhmrc : 282406
• 负责人: Prof Henry Krum
• 金额: $ 12.64万
• 依托单位国家: 澳大利亚
• 项目类别: NHMRC Project Grants
• 财政年份: 2004
• 资助国家: 澳大利亚
• 起止时间: 2004-01-01 至 2004-12-31
• 项目状态: 已结题
• 来源: https://researchdata.edu.au/perioperative-beta-blockade-poise-study/82758
• 关键词: Perioperative; beta; blockade; prevent; cardiac

Non-cardiac surgery is associated with significant risk of complications and death, particularly in elderly patients who are known to have heart disease, or who have risk factors for it (ie smoking, high blood pressure). About 11% of the Australian population are currently taking medications for heart disease or high blood pressure and about 80% have at least one risk factor for heart disease. As more than 2 million Australians have general anaesthesia for non-cardiac surgery every year, a substantial group of patients are therefore at risk of an adverse outcome following surgery. Despite the magnitude of this problem, however, few studies have established treatments to decrease the risk of complications and death following surgery. Beta-blockers are a group of drugs which have been used for decades in the treatment of heart disease and high blood pressure. Beta-blockers are known to improve the way the heart copes with the stress of surgery. They decrease the heart rate, make the heart more efficient at using energy and reduce the likelihood of imbalance between oxygen supply and demand. Some previous studies showed that beta-blockers may reduce the risk of heart attack and death for up to 2 years after surgery. However, other studies have shown no effect of beta-blockers on outcome. These previous studies have involved small numbers of patients who may not represent the broader population having surgery. We therefore propose to undertake a large trial to definitively answer the question about whether beta-blockers improve the outcome after non-cardiac surgery in patients with, or at risk of, heart disease. Even if the effect of beta-blockers is relatively modest, because such large numbers of patients with heart disease have surgery, the overall effect on the rate of complications and death in the population could be very significant. The results of this study could have major implications for the success of, and cost of, surgery worldwide.

非心脏手术与并发症和死亡的显著风险相关，特别是在已知患有心脏病或有心脏病风险因素（即吸烟，高血压）的老年患者中。大约11%的澳大利亚人目前正在服用心脏病或高血压药物，大约80%的人至少有一种心脏病风险因素。由于每年有200多万澳大利亚人因非心脏手术而接受全身麻醉，因此有相当一部分患者在手术后面临不良后果的风险。尽管这个问题的严重性，然而，很少有研究已经建立了治疗方法，以减少手术后并发症和死亡的风险。β受体阻滞剂是一组药物，已被用于治疗心脏病和高血压数十年。众所周知，β受体阻滞剂可以改善心脏应对手术压力的方式。它们可以降低心率，使心脏更有效地利用能量，并减少氧气供需失衡的可能性。一些先前的研究表明，β受体阻滞剂可以降低心脏病发作和手术后死亡的风险长达2年。然而，其他研究表明β受体阻滞剂对结局无影响。这些先前的研究涉及少数患者，他们可能不代表更广泛的手术人群。因此，我们建议进行一项大型试验，以明确回答β受体阻滞剂是否能改善心脏病患者或有心脏病风险患者非心脏手术后的结局。即使β受体阻滞剂的作用相对较小，但由于大量心脏病患者接受手术，对人群并发症和死亡率的总体影响可能非常显著。这项研究的结果可能对全球手术的成功和成本产生重大影响。