老年冠心病病人择期腹部大手术使用β受体阻滞剂的初步经验

Usage ofβ-blocker for elder patients with cardiovascular disease undergoing elective major abdominal op-eration during perioperative period

目的：我们根据2007年美国心脏病学会和美国心脏病协会（ACC/AHA）心脏病病例行非心脏手术围手术期手术评估及治疗方案指南,对老年冠心病病人进行择期腹部大手术应用β受体阻滞剂,观察其效果,总结初步经验。方法回顾性分析2011年3月至2015年3月接受择期腹部大手术且围手术期使用β受体阻滞剂的58例老年病例的临床资料。结果所有病例均为高风险手术,平均年龄79岁,修正心脏危险指数（revised cardiac risk index,RCRI）评分2分31例,RCRI≥3分27例,术后心肌缺血6例（10%）,心肌梗死3例（5%）,心律失常6例（10%）,心力衰竭3例（5%）,脑卒中0例（0%）,总的心脑血管并发症18例（31%）,死亡3例（5%）,2例死于心肌梗死,1例死于吻合口出血。RCRI≥3分组发生术后心脑血管并发症13例（48%）,明显高于 RCRI 2分组5例（16%）（P =0.009）。结论接受腹部大手术的老年冠心病病人围手术期应根据 RCRI 评分来应用β受体阻滞剂。

Objective To evaluate the efficacy ofβ-blocker for patients with cardiovascular dis-ease undergoing elective major abdominal operation according to the guideline of ACC/AHA in 2007. Methods From March 201 1 to March 201 5,a total of 58 elders were recruited to receive β-blocker during perioperative period and underwent major abdominal operation.Then the efficacy of β-blocker was evaluated.Results All patients underwent high-risk procedures.Their average age was 79 years. The scores of RCRI （Revised Cardiac Risk Index）were 2 points （n =3 1 ）and ≥3 points （n =27）. The complications included myocardial ischemia （n=6,10%）;myocardial infarction （n=3,5%）;arrhythmia （n=6,10%）and heart failure （n=3,5%）.Among 3 deaths,the causes were myocardial infarction （n=2）and anastomotic bleeding （n = 1 ）.The incidence of complications was significantly higher in RCRI ≥3 points group than that in RCRI 2 points group （n=13,48%;n=5,16%）（P =0. 009）.Conclusions Elder patients with cardiovascular disease undergoing major abdominal surgery should receiveβ-blocker therapy according to RCRI score.