美托洛尔注射液应用于老年非心脏手术患者围手术期的观察及对Fas细胞凋亡系统的影响

Effects of perioperative intravenous administration of metoprolol in elderly patients undergoing non-cardiac surgery and its effects on Fas apoptotic system

目的观察美托洛尔注射液应用于老年非心脏手术患者围手术期的疗效及其对Fas细胞凋亡系统的影响。方法将61例连续人选的老年患者(≥60岁)随机分为美托洛尔组(n=30)和安慰剂组(n=31),术前4h口服美托洛尔/安慰剂25 mg,术后每日给予美托洛尔注射液/安慰剂60mg,分4次缓慢泵入,直到患者可以口服药物,改为25mg/次,2次/d口服。记录血压、心率、心电图及心肌型肌酸激酶同工酶(CK-MB)、心肌肌钙蛋白I(cTnI),用ELISA法测定sFas、sFasL。结果美托洛尔组与安慰剂组相比,术后CK-MB和cTnI均有降低。[CK-MB:6 h:(3.5±2.6)vs(7.4±8.1)IU/L,1d:(4.3±4.1)vs(8.9±9.8)IU/L,2d:(4.6±4.1)vs(9.7±8.8)IU/L,3d(2.4±2.1)vs(7.8±7.5)IU/L,P<0.05;cTnI:1 d:(0.022±0.027)vs(0.045±0.03 1)μg/L,P<0.05]术后S T-T改变、心律失常较安慰剂组发生例数降低。sFas和sFasL浓度美托洛尔组较安慰剂组在术后3d明显降低[sFas:3d(3.7±2.4)vs(7.7±3.0)μg/L,P<0.01;sFasL(2.2±2.0)vs(7.0±2.7)μg/L,P<0.01]。结论美托洛尔注射液应用于老年患者围手术期具有心脏保护作用,可降低sFas和sFasL浓度,具有一定的抗细胞凋亡作用。

Objective To investigate the effects of perioperative intravenous administration of metoprolol in elderly patients undergoing non-cardiac surgery and its effects on apoptotic cytokines（sFas/sFasL）.Methods Sixty-one consecutive elderly patients（≥60 years） undergoing non-cardiac surgery were randomly assigned to metoprolol（n=30） or placebo（n=31） groups.Patients received oral administration of metoprolol or placebo before surgery（25mg）.After surgery,metoprolol or placebo was administrated intravenously（60 mg/d,including 4 injections）,followed by oral administration（25 mg twice daily） when it was accepted for patients.Blood pressure,heart rate,electrocardiogram,MB isoenzyme of creatine kinase（CK-MB）,and cardiac troponin- I（cTnI） were recorded.sFas and sFasL concentrations were determined by ELISA.Results Compared with placebo group,CK-MB and CTnI were significantly lower after surgery in metoprolol group[CK-MB（IU/L）：6 h：（3.5±2.6） vs（7.4±8.1）;1d：（4.3±4.1） vs（8.9±9.8）;2d：（4.6±4.1） vs（9.7±8.8）;3d： （2.4±2.1） vs（7.8±7.5）,P0.05;cTnI（μg/L）：1d：（0.022±0.027） vs（0.045±0.031）,P0.05].There were fewer cases presenting with arrhythmia or ST-T change in metoprolol group than in placebo group.After surgery,sFas and sFasL concentrations were significantly lower in metoprolol group than in placebo group[sFas（μg/L）：1 d：（5.4±2.4） vs（6.8±2.8）;2d：（5.6±2.7） vs（7.1±2.5）;3 d：（3.7±2.4） vs （7.7±3.0）;P0.05.sFasL（μg/L）：1d：（5.1±2.8） vs（6.5±2.6）;2d：（5.1±3.0） vs（6.7±2.8）;3d：（2.2±2.0） vs（7.0±2.7）,P0.05]. Conclusion Perioperative intravenous administration of metoprolol has cardiac protection effects for elderly patients undergoing non-cardiac surgery.It can decrease sFas and sFasL concentrations so as to exert anti-apoptotic effects.