β-受体阻滞剂在慢性阻塞性肺疾病患者的应用价值探讨

The value of beta blockers in patients with chronic obstructive pulmonary disease

目的探讨β-受体阻滞剂在慢性阻塞性肺疾病(简称慢阻肺)患者中的安全有效性及其对预后的影响。方法回顾性分析366例我科收治的慢阻肺急性加重期患者的病历资料,评估β-受体阻滞剂的使用率和相关事件,对合并症、适应证、禁忌证及相关临床指标进行分析。结果 366例患者中,156例(42.6%)至少有1种使用β-受体阻滞剂的适应证,这些患者中使用β-受体阻滞剂的仅53例(34.0%),无禁忌但未使用β-受体阻滞剂的有61例(39.1%)。入院时使用β-受体阻滞剂的患者有72例(19.7%),使用抗血小板药物177例(45.6%),使用他汀类药物145例(39.6%),使用血管紧张素转换酶抑制剂/血管紧张素Ⅱ受体阻滞剂168例(45.9%)。25例(6.8%)在住院期间发生了缺血性心脏病事件,57例(15.6%)在入院期间发生心脑血管事件。发生心脑血管事件的患者住院时间更长(P<0.01),住院死亡率更高(P=0.02)。结论慢阻肺患者有明确的β-受体阻滞剂使用适应证,但临床上使用率仍然很低。需要进一步的研究来探讨对慢阻肺患者β-受体阻滞剂的应用。

Objectives To explore the safety and efficacy of beta-blockers(BBs) in patients with chronic obstructive pulmonary disease(COPD) and its effect on prognosis.Methods The data of 366 patients with acute exacerbation of COPD in this department were analyzed retrospectively.The use rate and related events of BBs were evaluated,including comorbidity,indications,contraindications and related clinical indicators.Results Of the 366 patients,156(42.6%) had at least one indication of the use of BBs,but only 53(34.0%) of these patients used BBs,and 61 patients(39.1%) had no contraindications but did not use BBs.At admission,72 patients(19.7%) were treated with BBs,177(45.6%) with antiplatelet drugs,145(39.6%) with statins,and angiotensin converting enzyme inhibitor/angiotensin II receptor blocker was used in 168(45.9%) patients.Twenty-five patients(6.8%) had ischemic heart disease during hospitalization.Fifty-seven patients(15.6%) had cardiovascular and cerebrovascular events during admission.The patients with cardiovascular and cerebrovascular events had longer hospitalization(P<0.01) and higher in-hospital mortality(P=0.02).Conclusions Patients with COPD have a clear indication of BBs use,but the clinical use rate is still very low.Further research is needed to explore the prescription disorders of BBs in patients with COPD.