【摘要】 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。更多还原

【Abstract】 Objective To evaluate the efficacy of p-blocker for patients with cardiovascular disease undergoing elective major abdominal operation according to the guideline of ACC/AHA in 2007.Methods From March 2011 to March 2015,a total of 58 elders were recruited to receive β-blocker during perioperative period and underwent major abdominal operatioa 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 = 31) 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 receive β-blocker therapy according to RCRI score.更多还原