摘要:目的：探讨β受体阻滞剂在慢性心力衰竭急性失代偿情况下的正确应用。方法：对我院2005年1月～2006年12月收治的104例确诊慢性心力衰竭急性失代偿并使用β受体阻滞剂患者的治疗措施及预后转归进行回顾性分析。结果：104例患者男性61例，女性43例，平均年龄64.4±17.5岁，其中45～70岁占6792。好转占85%，死亡占10%，建议外出心脏移植5%。停止使用β受体阻滞剂的19人中17人重新恢复了使用，减量的65人中，59人的β受体阻滞剂重新加量至入院前的水平。结论：慢性心力衰竭在急性失代偿期合理使用β受体阻滞剂对患者预后有重要意义。心力衰竭急性失代偿控制后，β受体阻滞剂应恢复使用并逐渐增量至一个合理的剂量长期使用。
Objective To evaluate the effects of cardioselective beta-blockers on respiratory function in patients with chronic obstructive pulmonary disease ( COPD) . Methods We used computer to search the Cochrane Controlled Trials Register database, Medline, Netherlands EMBASE/Excerpta Medica,EBSCO database, China Academic Journal and the Chinese Biomedical Literature Database, as well as respiratory magazines and conference abstracts, without language restrictions. The information was retrieved until December 2011. We collected all the randomized, blinded, controlled clinical trails ( RCTs ) of cardioselective beta-blockers on respiratory function in patients with COPD. Then two evaluators evaluated the quality of RCTs according to the Cochrane Review Manual 4. 2 independently. Meta-analysis was performed using statistical software Stata 11. 0. X2 test was used to analyze their heterogeneity. Standardizedmean difference ( SMD) was used to describe continuous variables. Relative risk degree ( RR) was used to describe categorical variables, and 95% CI was used to describe treatment effect. Results 22 trails met the selection criteria. Meta-analysis showed no change of FEV1 in COPD patients after taking single dose of cardioselective beta-blockers [ SMD - 0. 367, 95% CI( - 0. 786, 0. 052) ] and no respiratory symptoms aggravation [ RR1. 000, 95% CI( 0. 848, 1. 179) ] . Meta-analysis also showed no change of FEV1 in COPD patients who received long-term cardioselective beta-blockers treatment [ SMD - 0. 236, 95% CI( - 0. 523,0.051) ] , and no respiratory symptoms aggravation [ RR 1. 000, 95% CI ( 0. 830, 1. 205) ] . Inhaled beta-2 agonists showed no effect on FEV1 in COPD patients after either long-term administration [ SMD - 0. 200,95% CI( - 0. 586, 0. 187) ] or single dose administration of cardioselective beta-blockers [ SMD - 0. 078,95% CI( - 0. 654, 0. 497) ] . Conclusion Cardioselective beta-blockers, given to patients with COPD in conditions such as heart failure, coronary artery disease and hypertension in the identified studies did not produce adverse respiratory effects.
Objective To systematically review the influence of tight heart rate (HR) control on the efficacy of perioperative β-blockade, and discuss the effective measures of perioperative myocardial protection. Methods We searched the PubMed, OVID, EMbase, the Cochrane Library and Chinese Biomedical Database (CBM) for randomized controlled trials on evaluating perioperative β-blockers after noncardiac surgery. The quality of the included studies was evaluated by the method recommended by the Cochrane Collaboration. Meta-analyses was conducted by using the Cochrane Collaboration’s RevMan software. Results Thirteen RCTs including 11 590 patients were included. The combined results of all studies showed cardioprotective effect of β-blockers (OR=0.64, 95%CI 0.50 to 0.80, P=0.000 1), with considerable heterogeneity among the studies (I2=57%). However, grouping the trials on the basis of maximal HR showed that trials where the estimated maximal HR was 100 bpm were associated with cardioprotection (OR=0.37, 95%CI 0.26 to 0.52, Plt;0.000 01) whereas trials where the estimated maximal HR was 100 bpm did not demonstrate cardioprotection (OR=1.13, 95%CI 0.81 to 1.59, P=0.48) with no heterogeneity (I2=0%). Conclusion The evidence suggests that effective control of HR is important for achieving cardioprotection and that administration of β-blockers does not reliably decrease HRs in all patients. Judicious use of combination therapy with other drugs may be necessary to achieve effective postoperative control of HR.
目的 观察β受体阻滞剂卡维地洛和美托洛尔对高血压性心脏病患者左室心肌质量的影响。 方法 将2005年6月－2007年6月收治的260例原发性高血压性心脏病患者，随机分为A、B两组，每组130例。均停用其他降压药物1周后，A组服用卡维地洛，B组服用美托洛尔。两组第1周均服用12.5 mg，2次/d；无明显心动过缓或血压明显下降者，第2周改服25 mg，2次/d，必要时均加用硝苯地平控释片以血压降低至正常范围，心率≥55次/min为宜，每2周加量，最大剂量为50 mg ，2次/d。疗程6个月。观察指标：分别于用药前后测定患者左室舒张末内径（LVDd）、左室射血分数（LVEF）、室间隔厚度（LVST）及左室后壁厚度（PWT）。计算左室心肌质量（LVMW）、左室心肌质量指数（LVWI）。 结果 A、B两组在试验前后分别作自身对比，LVDd减小，LVST及PWT变薄，LVEF增高，LVWI降低差异有统计学意义（P＜0.01）；A、B两组在试验后对比，差异无统计学意义（P＞0.05）。 结论 卡维地洛、美托洛尔应用于高血压心脏病患者，可有效降低血压和减慢心率，减少心肌耗氧量，降低左室负荷及神经激素的活动，减轻左室肥厚，减低心肌质量。
ObjectiveTo explore an individualized treatment program to prevent the initial bleeding of a patient with cirrhosis and esophageal varices by the methods of evidence-based medicine. MethodsOne patient with cirrhosis and esophageal varices was admitted into our hospital on November 2, 2013. After evaluating the patient's condition adequately, we proposed the problem according to the PICOS principles. Then, we assessed the clinical evidence from the Cochrane Library (1990-2012), Medline (1950-2012), Embase (1991-2012), VIP (1989-2013), and CBM (1990-2013). The individualized treatment plan was made through doctors' experiences and analysis of those high-quality evidences from the databases. ResultsEight studies (randomized controlled trials and 5 meta-analysis) were included. We evaluated a series of associated problems:whether we should take measurement to prevent initial bleeding of esophageal varices; which one (β-blockers or ligation of esophageal varices) was the best method to prevent the initial bleeding based on efficacy, complication and cost-effectiveness. Then, according to the evidences and the patient's view, we gave non-selectiveβ-blocker as the primary prevention. After one-year followed-up, the initial bleeding of the patient did not occur. ConclusionMaking the prevention plan for a patient with cirrhosis and esophageal varices can not only find out the individualized program, but also push the patient to make decision for their own health.
ObjectiveTo compare the effectiveness of different β-blockers for preventing postoperative atrial fibrillation (POAF) after cardiac surgery. Methods Databases of PubMed, Science Direct, Web of Science, The Cochrane Library, SinoMed, CKNI, VIP, WanFang were searched by the computer from inception to April 31, 2022 to collect randomized controlled studies on the comparison of the effectiveness of different β-blockers for preventing POAF. Two investigators independently screened the literature and extracted information. The quality of the literature was evaluated using Cochrane bias risk tool, and RevMan 5.3 and STATA 17.0 were used for meta-analysis. Results A total of 17 randomized controlled studies with 3 290 patients were included. Direct meta-analysis showed that landiolol and metoprolol were more effective than placebo (P≤0.001), and carvedilol was more effective than metoprolol in preventing the development of POAF (P<0.001). Network meta-analysis showed that landiolol, carvedilol and metoprolol were more effective than placebo in preventing the incidence of POAF (P<0.05). Landiolol and carvedilol were more effective than metoprolol, and carvedilol were more effective than nebivolol (P<0.05). The surface under the cumulative ranking curve from high to low were carvedilol, landilol, propranolol, atenolol, metoprolol, and nebivolol. Conclusion Carvedilol and landilol have different degrees of improvement in the occurrence of POAF, and carvedilol has the best preventive effect. More studies are required to verify the strength of evidence due to the limited sample size.