関連する実験動画
心臓外科外科手術を受ける患者における手術前ベータブロッカー:メタ解析
Sripal Bangalore1, Jørn Wetterslev, Shruthi Pranesh
1Division of Cardiology, Brigham and Women's Hospital, Boston, MA, USA.
Lancet (London, England)
|November 18, 2008
まとめ
心臓外科手術以外のベータブロッカーの治療は,死亡率や心不全を有意に低下させない. 心臓発作や缺血を減少させるかもしれないが,脳卒中のリスクや,ブラジカルディアや低血圧などの副作用を増加させる.
科学分野:
- 心臓病学 心臓病学
- アネステシオロジー アネステシオロジー
- クリニック・トライアル 臨床試験
背景:
- 現在のガイドラインでは,非心臓外科手術ではベータブロッカーを推奨しています.
- いくつかの試験では,この推奨の有効性を疑問視しています.
研究 の 目的:
- 心臓外科外科におけるベータブロッカーの使用に関する証拠を批判的に検討する.
- 術後の臨床結果と安全性への影響を評価する.
主な方法:
- 33件のランダム化対照試験のシステマティックレビュー.
- 心臓外科手術以外の手術を受けた患者12,306人を含む.
- 死亡率,心筋梗塞,脳卒中,心不全,イシュケミア,ブラジカルディア,低血圧,および支氣管縮に関する抽出したデータ.
主要な成果:
- ベータブロッカーは全因死亡率,心血管疾患死亡率,心不全を減少させなかった.
- 致命的でない心筋梗塞と缺血の減少と関連しています.
- 非致命的な脳卒中,ブラディカルディア,低血圧のリスクが増加します.
- 有益な効果は主に高リスク試験によるものです.
結論:
- 現在の証拠は,非心臓外科手術における手術前後の結果に対するベータブロッカーの日常的な使用を支持していません.
- ACC/AHAのガイドラインは,この介入の強力な提唱を再検討すべきである.
- 広く推奨される前に,さらなる決定的な証拠が必要である.
関連する概念動画
Adrenergic Antagonists: Pharmacological Actions of β-Receptor Blockers
β-receptor blockers significantly impact the cardiovascular system by counteracting catecholamine-induced sympathetic responses. These medications decrease heart rate, contractility, and cardiac output, potentially leading to cardiac depression, life-threatening bradycardia, and death. Therapeutically, β-blockers function as mild antihypertensives and are utilized in treating angina pectoris and cardiac arrhythmias. However, nonselective β-blockers inhibit β2-receptors in bronchial smooth...
Antihypertensive Drugs: Types of β-Blockers
β receptors are classified into three subclasses: β1, β2, and β3. β1 receptors are primarily located in the heart and kidneys. When they get activated, they increase heart rate, contractility, and renin release. This process enhances blood pressure and aids in stress management. In contrast, β2 receptors are situated mainly in the lungs, blood vessels, and skeletal muscles. Upon activation, they trigger smooth muscle relaxation, causing bronchodilation and vasodilation. This widens airways and...
Heart Failure Drugs: β-Blockers
β-adrenergic antagonists, commonly known as β-blockers, block the effects of sympathetic neurotransmitters such as noradrenaline (NA) and adrenaline (ADR). They have several beneficial effects in heart failure treatment. They reduce heart rate, the force of contraction, and cardiac muscle relaxation. They also slow the atrial-ventricular conduction rate and raise the threshold for arrhythmias. The concentration of β-blockers determines their effects on bronchodilation, vasodilation, and...
Cardiomyopathy VII: Pre and Post Operative Nursing Management
Patients with hypertrophic cardiomyopathy (HCM) and left ventricular outflow tract (LVOT) obstruction who remain symptomatic despite optimal medical therapy may undergo a septal myectomy (Morrow procedure). This procedure involves excising a portion of the hypertrophied septum below the aortic valve using a heart-lung machine to improve blood flow through the LVOT. Effective preoperative and postoperative nursing management ensures successful patient outcomes, minimizes complications, and...
Adrenergic Antagonists: ɑ and β-Receptor Blockers
Third-generation β-blockers, such as labetalol and carvedilol, represent a significant advancement in managing cardiovascular conditions. Unlike conventional β-blockers, which can induce peripheral vasoconstriction, third-generation drugs block α1 adrenoceptors. This promotes vasodilation through several mechanisms, such as increased nitric oxide production, inhibition of calcium ion entry, opening of potassium ion channels, and antioxidant action. Labetalol, for instance, is clinically...
Antiarrhythmic Drugs: Class II Agents as β-Adrenergic Blockers
Adrenergic stimulation generally impacts cardiac rate and rhythm. Specifically, stimulation of the β-adrenoceptors triggers an increase in intracellular calcium ion influx and pacemaker currents, which may cause arrhythmias. Catecholamines like adrenaline also demonstrate β2-adrenoceptor-mediated hypokalemia, impacting cardiac action potential and disrupting the normal cardiac rhythm. Class II antiarrhythmic drugs are β-adrenoceptor antagonists or β-blockers, which indirectly block calcium...