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首页> 外文期刊>Canadian journal of surgery: Journal canadien de chirurgie >Prophylactic beta-blockade to prevent myocardial infarction perioperatively in high-risk patients who undergo general surgical procedures.
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Prophylactic beta-blockade to prevent myocardial infarction perioperatively in high-risk patients who undergo general surgical procedures.

机译：预防性β受体阻滞剂可在接受一般外科手术的高危患者围手术期预防心肌梗塞。

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INTRODUCTION: The benefit of administering beta-adrenergic blocking agents perioperatively to surgical patients at high risk for myocardial ischemia has been demonstrated in several well-designed randomized controlled trials. These benefits have included a reduction in the incidence of myocardial complications and an improvement in overall survival for patients with evidence of or at risk for coronary artery disease (CAD). We designed a retrospective study at the Ottawa Civic Hospital to investigate the use of beta-blockers in the perioperative period for high-risk general surgery patients who underwent laparotomy and to explore the reasons for failure to prescribe or administer beta-blockers when indicated. METHODS: All 236 general surgery patients over the age of 50 years who underwent laparotomy for major gastrointestinal surgery between Jan. 1, 2001, and Dec. 31, 2001, were assigned a cardiac risk classification using the risk stratification described by Mangano and colleagues. The perioperative prescription and administration of beta-blockers were noted as were the patient's heart rate and blood pressure parameters for the first postoperative week, in-hospital adverse cardiac events and death. RESULTS: Of the 143 patients classified as being at risk for CAD or having definite evidence of CAD, 87 (60.8%) did not receive beta-blockers perioperatively. Of those who did, 43 were previously on beta-blockers and 13 had them ordered preoperatively. Patients with definite CAD were significantly more likely than others to receive beta-blockers perioperatively (p < 0.001), as were patients seen by an anesthesiologist or an internist preoperatively (p < 0.001). Twenty (33%) of the 61 patients who were already taking beta-blockers preoperatively had them inappropriately discontinued postoperatively. Once prescribed by the physician, beta-blockers were administered by the nurses irrespective of nil par os status. The mean heart rate and blood pressure parameters for patients receiving beta-blockers postoperatively was 82 beats/min and 110 mm Hg, respectively, and these values were not significantly different from the mean heart rate of patients not receiving beta-blockers. The number of postoperative cardiac events was significantly higher in patients with definite evidence of CAD, and among this group, the use of beta-blockers was associated with a significant reduction in postoperative cardiac events. This was not true for patients at risk for CAD or patients with no risk of CAD. CONCLUSIONS: A significant proportion (> 60%) of general surgery patients who were identified as having definite evidence of, or being at risk for, CAD were not prescribed beta-blockers preoperatively. More than 30% of patients who were on beta-blockers preoperatively did not have them reordered postoperatively. These results may reflect controversy surrounding the recommendations, miscommunication between surgeons and anesthesiologists and errors in postoperative ordering.
机译：简介：在一些精心设计的随机对照试验中已证明，对患有心肌缺血高风险的手术患者围手术期给予β-肾上腺素能阻断剂是有好处的。这些好处包括减少有冠状动脉疾病（CAD）证据或处于危险中的患者的心肌并发症发生率，并改善总体存活率。我们在渥太华市立医院设计了一项回顾性研究，以调查在接受剖腹手术的高危普外科患者围手术期使用β-受体阻滞剂的情况，并探讨在指定时未开处方或使用β-阻滞剂的原因。方法：对2001年1月1日至2001年12月31日进行大肠胃切除手术的236名年龄在50岁以上的普外科手术患者，按照Mangano及其同事所述的风险分层进行心脏风险分类。注意到围手术期的处方药和β-受体阻滞剂的使用，以及术后第一周患者的心率和血压参数，院内不良心脏事件和死亡。结果：在143名有CAD风险或有明确CAD证据的患者中，有87名（60.8％）没有围手术期接受β受体阻滞剂治疗。在这些患者中，有43位以前使用过β受体阻滞剂，还有13位在术前下令使用。明确CAD的患者围手术期接受β受体阻滞剂的可能性显着高于其他患者（p <0.001），麻醉师或内科医师在手术前所见的患者（p <0.001）。术前已经服用β受体阻滞剂的61例患者中有20例（33％）术后不适当地停用了它们。一旦由医生开具处方，护士将使用β受体阻滞剂，而无需考虑任何状态。术后接受β受体阻滞剂的患者的平均心率和血压参数分别为82次/分钟和110 mm Hg，这些值与未接受β受体阻滞剂的患者的平均心率无显着差异。有明确证据的CAD患者术后心脏事件的数量显着增加，在这一组患者中，使用β受体阻滞剂可显着减少术后心脏事件。对于有CAD风险的患者或无CAD风险的患者而言，情况并非如此。结论：绝大部分（> 60％）的确诊为CAD明确证据或有CAD风险的普通外科患者术前未开β-受体阻滞剂。术前使用β受体阻滞剂的患者中有30％以上没有在术后重新排序。这些结果可能反映了围绕建议的争议，外科医生与麻醉师之间的沟通不畅以及术后订购方面的错误。

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