β阻滞剂在围手术期的应用.pptxVIP

β阻滞剂在围手术期的应用;;;CABG: 8,482例 ；PTCA: 13,997例一年死亡率统计 (one-year mortality rate)( P0.001 ) ：β－阻滞剂治疗 (group withβ-blocker therapy) ： 12.3% 未β－阻滞剂治疗 (group without β-blocker therapy)： 23.6%冠脉血管重建:β阻滞剂能明显降低一年死亡率; CABG: β-blocker therapy significantly decrease one-year mortality;β－阻滞药围术期心脏的保护作用Heart protective effect of β-blockor in perioperative period;95年开始美托洛尔渐渐成为CABG围术期处理心脏事件的常用药物Metoprolol has been becoming a drug in common use in treating cardiac events in perioperative period since 1995.;96年6月后， β－阻滞药开始作为冠心病术前用药。现已在某些瓣膜病、先心病、大动脉瘤术前用药中广泛应用 β-blockor began to be a drug using preoperatively after June 1996. Nowadays, it is administrated broadly before big cardiac operations.β阻滞药已成为心脏手术中困难复苏非常规处理的主要药物 β-blockor has become a main drug in treating unsuccessful resuscitation except the general treatments.;病例(case);静注鱼精蛋白循环尚稳定; 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;临床症状(clinical symptoms) 急性肺水肿，粉红色泡沫样痰 Acute pulmonary edema, pink foaming spittle 高气道压力 High pressure in airway 心电图ST段明显抬高 ST segment elevated significantly in ECG 反复恶性心律失常：室速 室颤 Repeated fatal arrhythmia: ventricular tachycardia, ventricular fibrillation 低血压(SBP70~75mmHg) Hypotension ;治疗经过Therapeutic process;β－阻滞药围术期脑保护作用Brain protective effect of β-blockor in perioperative period;β－阻滞剂治疗的病人，意识模糊、谵妄和一过性缺血发作的发生率为3.9％，未用者为8.2％Among patients using β-blockor , neurological complication : 3.9％; otherwise:8.2％比较2575例CABG的??归证实了术中β－阻滞剂的脑保护作用Prognosis of 2575 cases experiencing CABG demonstrated the brain protective effect of β-blockor administered during operation.;?-阻滞剂降低高危病人手术死亡率β-blockor decreased surgery mortality rate in high risk patients; ?受体阻滞剂组 安慰剂组 P值