β阻滞药在围手术期的应用课件.ppt

1、编辑课件李立环李立环Li Lihuan北京阜外心血管病医院北京阜外心血管病医院 Fu Wai Hospital(Beijing)编辑课件 编辑课件标准治疗+受体阻滞剂Standard Therapy+-blocker 标准治疗组Standard TherapyP值P Value心血管死亡(Cardiovascular Death)3.4%17%=0.02非致死性心梗(Nonfatal Myocardial Infarction)0.0%17%0.001致死性心梗(Fatal Myocardial Infarction)0.0%17%0.001N Engl J Med 1999;341:1789

2、-94编辑课件 Archives of Internal Medicine 2000,160:947编辑课件编辑课件 北京阜外心血管病医院麻醉科从90年起术中尝试使用阻药处理心脏事件，取得的效果挑战了对心脏事件处理的传统观念 The department of anaethesia of our hospital has tried using-blockor to treat cardiac events since 1990s and its results challenged the traditional concept of treating these events.编辑课件编辑

3、课件编辑课件 体外循环下冠脉搭桥 (CABG under cardiopulmonary bypass)术前病情偏重，EF约40，未放置漂浮导管;Relatively severe condition before operation,EF about 40%,pulmonary artery catheter unlocated;停机时给予0.03ug/kg/min肾上腺素辅助循环;0.03ug/kg/min epinephrine to support circulation stability after stopping cardiopulmonary bypass;编辑课件 静注鱼精

4、蛋白循环尚稳定;Hemadynamic stability during protamine intravenous administration;鱼精蛋白注毕后约5min血压下降，加大肾上腺素用量血压上升;Blood pressure decreased 5 minutes after portamine administration，elevated after increasing dose of epinephrine;数分钟后出现下列临床征象 Following symptoms occurred few minutes later编辑课件 临床症状(clinical symptom

5、s)s 急性肺水肿，粉红色泡沫样痰 Acute pulmonary edema,pink foaming spittles 高气道压力 High pressure in airways 心电图ST段明显抬高 ST segment elevated significantly in ECGs 反复恶性心律失常：室速 室颤 Repeated fatal arrhythmia:ventricular tachycardia,ventricular fibrillations 低血压(SBP7075mmHg)Hypotension编辑课件s 美托洛尔1mg后血压维持原水平略有上升，室速室颤频率，心率减

6、慢约34bpm After 1mg metoprolol administration,blood pressure elevated,occurrence of VT,VF decreased,heart rate reduced by 34bpms 美托洛尔1mg后血压上升到808590mmHg，室速室颤消失，ST段恢复，循环稳定 After 1mg metoprolol administration,VT,VF vanished,ST segment lowered to normal and hemodynamic stable when blood pressure increase

7、d to 808590mmHg编辑课件 Newman：CABG中应用阻滞剂，卒中发生率为1.9，未用者为4.3 Newman:Among patients using-blockor in CABG,incidence rate of stroke:1.9;otherwise:4.3编辑课件编辑课件编辑课件 受体阻滞剂组 安慰剂组 P值 -blockor placebo p value （n=99）（n=101）总 6个月 0.0%8.0%0.001 死 six month 亡 第1年 3.0%10%=0.005 率 one year Total 第2年 10%21%=0.019mortali

8、ty two year rate N Engl J Med 1996;335:1713-20编辑课件编辑课件 1996年到1999年，手术前-受体阻滞剂的总使用率从50%增加到60%（P240mg/dL(6.2mmol/L)(serum total cholesterol 240mg/dL)5.有糖尿病但尚未需要胰岛素治疗者 (diabetes without receiving insulin therapy)编辑课件编辑课件编辑课件编辑课件The Evidence Is In,Now the Work Begins”Physicians can no longer accept the argumentthat absence of adequate knowledge is a reasonfor underuse of beta-blockers.The data are overwhelming and they have been published inleading medical journals.”Califf RM,OConnor CM.Editorial,JAMA 2000;283:1335-1337RM Califf,CM OConnor.Editorial,JAMA: