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

非心脏手术与并发症和死亡的重大风险相关，特别是对于已知患有心脏病或具有心脏病风险因素（如吸烟、高血压）的老年患者。约11%的澳大利亚人目前正在服用治疗心脏病或高血压的药物，约80%的人至少有一种心脏病风险因素。由于每年有超过200万澳大利亚人在非心脏手术中进行全身麻醉，因此大量患者面临手术后不良后果的风险。然而，尽管这个问题很严重，很少有研究确定了降低手术后并发症和死亡风险的治疗方法。-受体阻滞剂是一组已经使用了几十年的药物，用于治疗心脏病和高血压。已知-受体阻滞剂可以改善心脏应对手术压力的方式。它们降低心率，使心脏更有效地利用能量，减少氧气供需不平衡的可能性。一些先前的研究表明-受体阻滞剂可以在术后2年内降低心脏病发作和死亡的风险。然而，其他研究表明-受体阻滞剂对结果没有影响。这些先前的研究只涉及一小部分患者，这些患者可能不能代表接受手术的更广泛人群。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预后。即使受体阻滞剂的效果相对温和，因为如此多的心脏病患者接受了手术，对人群中并发症和死亡率的总体影响可能是非常显著的。这项研究的结果可能会对全世界手术的成功和成本产生重大影响。

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.