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朝鲜．日本医学资料 1989年第3期10卷 70-72页

作者：古贺义则李仙女

β阻断剂对无心肌梗死或充血性心衰病史的冠状动脉疾病患者的死亡率和未来心肌梗死发生率的影响

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世界核心医学期刊文摘（心脏病学分册） 2005年第9期1卷 30-31页

作者： Bunch T. J. Muhlestein J. B. Bair T. L. 刘健 Dr. Cardiovascular Department LDS Hospital 8th Avenue and C Street Salt Lake CityUT 84143United States

Beta-blocker therapy has been shown to benefit patients who have coronary artery disease and present with acute myocardial infarction(AMI) and/or congestive heart failure(HF). However, whether β-blocker therapy provides a similar benefit in patients who have coronary artery disease but not AMI or HF is unknown. A population of 4,304 patients who did not have HF but did have angiographically confirmed coronary artery disease(≥1 stenosis of ≥70%) without AMI at hospital presentation was evaluated. Baseline demographics, cardiac risk factors, clinical presentation, therapeutic procedures, and discharge medications were recorded. Patients were followed for a mean of 3.0±1.9 years(range 1 month to 6.9 years) for outcomes of all-cause death or AMI. Patients’average age was 65±11 years and 77%were men. Overall, 10%died and 5%had a nonfatal AMI. Discharge β-blocker prescription was associated with an increased event-free AMI survival rate for all-cause death(no βblocker 88.3%, βblocker 94.5%, p< 0.001) and death/AMI(no βblocker 83.4%, βblocker 89.2%, p< 0.001) but not non-fatal AMI(no βblocker 93.6%,βblocker 94.1%, p=0.60). After adjustment for 16 covariates, including statin prescription, angiotensin-converting enzyme inhibitor prescription, and type of baseline therapy, the effect of βblockers on the combination end point of death/AMI was eliminated. However, the effect of βblockers on death remained(hazard ratio 0.66, 95%confidence interval 0.47 to 0.93, p=0.02). Thus, βblockers are clearly indicated for most patients who have HF or AMI, and our results suggest that patients who have coronary artery disease without these conditions have approximately the same protective benefit against death. No effect was observed on longitudinal incidence of AMI or the combination of death/nonfatal MI.

关键词：充血性心衰 β阻断剂非致死性联合终点全因死亡他汀类药物血管造影使用指征

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利尿剂、β阻断剂和α_1阻断剂的最近话题

日本医学介绍 1999年第12期20卷 545-546页

作者：杜军

在急性给予β阻断剂后的恢复阶段观察心室壁运动异常增强了多巴酚丁胺负荷超声心动图的灵敏性

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世界核心医学期刊文摘（心脏病学分册） 2006年第6期2卷 32-33页

作者： Karagiannis S.E. Bax J.J. Elhendy A. D. Poldermans 姜朝晖 Department of Cardiology Erasmus MC Rotterdam Netherlands Dr.

Dobutamine stress echocardiography(DSE) has a modest sensitivity for detecting single- vessel coronary artery disease(CAD). This study assessed the additional diagnostic value of new or worsening wall motion abnormalities during recovery after acute administration of β blockers. The study population consisted of 200 patients(mean 59± 11 years of age, 144 men), who underwent DSE. Images were acquired at rest, low dose, peak dose, and during recovery. Patients received intravenous metoprolol(1 to 5 mg/min). The dose was adjusted to achieve a recovery heart rate within a 10% range of heart rate at rest. Coronary angiography was performed within 2 months. Inducible new wall motion abnormalities were observed in 168 patients(84% ) at peak stress. An additional 14 patients(7% )developed new or worsening wall motion abnormalities during recovery. CAD was detected in 182 patients(86 had single- vessel CAD). Sensitivity, specificity, and accuracy of DSE were 88% , 65% , and 73% at peak stress and 97% , 65% , and 74% during recovery. Sensitivity was particularly higher during recovery than during peak stress in patients with single- vessel CAD(98% vs 81% , p< 0.001). In conclusion, assessment of wall motion abnormalities during the recovery phase after acute β blockade improves sensitivity of DSE, particularly in patients with single- vessel CAD.

关键词：多巴酚丁胺负荷超声心动图室壁运动异常 β阻断剂灵敏性恢复阶段急性单支血管病变 AD患者冠状动脉疾病冠状动脉造影

β阻断剂对择期手术老年患者的作用:基于人群的回顾性队列研究

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世界核心医学期刊文摘(心脏病学分册) 2006年第4期 18-18页

作者： Redelmeier D. A. Scales D. C. Kopp A. 任付先

Objective: To test whether atenolol(a long acting βblocker)and metoprolol(a short acting βblocker)are associated with equivalent reductions in risk for elderly patients undergoing elective surgery. Design: Population based, retrospective cohort analysis. Setting: Acute care hospitals in Ontario, Canada, over one decade. Participants: Consecutive patients older than 65 who were admitted for elective surgery, without symptomatic coronary disease. Main outcome measure: Death or myocardial infarction. Results: 37 151 patients were receiving atenolol or metoprolol before surgery, of which the most common operations were orthopaedic or abdominal procedures. As expected, the two groups were similar in demographic characteristics, medical therapy, and type of surgery.1038 patients experienced a myocardial infarction or died, a rate that was significantly lower for patients receiving atenolol than for those receiving metoprolol(2.5%v 3.2%, P< 0.001). The decreased risk with atenolol persisted after adjustment for measured demographic, medical, and surgical factors; extended to comparisons of other long acting and short acting βblockers; was accentuated in analyses that focused on patients with the clearest evidence of βblocker treatment; and reflected the immediate postoperative interval. Conclusions: Patients receiving metoprolol do not have as low a perioperative cardiac risk as patients receiving atenolol, in accord with possible acute withdrawal after missed doses.

关键词：老年患者择期手术 β阻断剂

应用心脏再同步化治疗优化心衰和QRS持续时间延长患者的β阻断剂治疗

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世界核心医学期刊文摘（心脏病学分册） 2005年第9期1卷 35-35页

作者： Aranda Jr. J.M. Woo G.W. Conti J.B. 闫庆峰 Dr. Division of Cardiovascular Medicine University of Florida College of Medicine Gainesville FL United States

Aretrospective analysis was performed on 52 patients with heart failure to determine the change in β-blocker therapy after cardiac resynchronization therapy(CRT). After 6 months of CRT, the number of patients receiving β-blocker therapy increased from 36 to 44, with improved clinical outcomes and larger β-blocker doses, indicating that these 2 therapies may work together to improve outcomes by allowing the use of larger doses of βblockers while correcting ventricular dyssynchrony.

关键词：心脏再同步化 QRS β阻断剂持续时间剂量应用协同作用

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09015 β阻断剂仍是老年患者的一线药

国外药讯 2007年第9期 12-12页

作者：金伟秋（摘）

加拿大的研究人员报告称，尽管最近有证据说明β受体阻断剂（Ⅰ）不如其他的抗高血压药物，但仍是老年患者处方的一线药。在他们的回顾性研究中，评估了1994年7月1日至2002年3月31日安他略市所有没有合并心血管病变或动脉粥样硬化靶器... 详细信息

加拿大的研究人员报告称，尽管最近有证据说明β受体阻断剂（Ⅰ）不如其他的抗高血压药物，但仍是老年患者处方的一线药。在他们的回顾性研究中，评估了1994年7月1日至2002年3月31日安他略市所有没有合并心血管病变或动脉粥样硬化靶器官损伤的老年高血压患者（194761例）。一项随机对照试验、

关键词：老年患者一线药 β阻断剂老年高血压患者抗高血压药物 β受体阻断剂动脉粥样硬化随机对照试验

非心脏手术围手术期使用β阻断剂的证据有多强?对一系列随机对照试验的系统性回顾与荟萃分析

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世界核心医学期刊文摘（心脏病学分册） 2006年第1期2卷 17-17页

作者： Devereaux P. J. Beattie W. S. Choi P. T.-L. 朱冰坡 Department of Clinical Epidemiology and Biostatistics McMaster University Health Sciences Centre 1200 Main Street West Hamilton Ont. L8N 3Z5 Canada

Objective: To determine the effect of perioperative βblocker treatment in patients having non-cardiac surgery. Design: Systematic review and meta-analysis. Data sources: Seven search strategies, including searching two bibliographic databases and hand searching seven medical journals. Study selection and outcomes: We included randomised controlled trials that evaluated βblocker treatment in patients having non-cardiac surgery. Perioperative outcomes within 30 days of surgery included total mortality, cardiovascular mortality, non-fatal myocardial infarction, non-fatal cardiac arrest, non-fatal stroke, congestive heart failure, hypotension needing treatment, bradycardia needing treatment, and bronchospasm. Results: Twenty two trials that randomised a total of 2437 patients met the eligibility criteria. Perioperative βblockers did not show any statistically significant beneficial effects on any of the individual outcomes and the only nominally statistically significant beneficial relative risk was 0.44(95%confidence interval 0.20 to 0.97, 99%confidence interval 0.16 to 1.24) for the composite outcome of cardiovascular mortality, non-fatal myocardial infarction, and non-fatal cardiac arrest. Methods adapted from formal interim monitoring boundaries applied to cumulative meta-analysis showed that the evidence failed, by a considerable degree, to meet standards for forgoing additional studies. The individual safety outcomes in patients treated with perioperative βblockers showed a relative risk for bradycardia needing treatment of 2.27(95%CI 1.53 to 3.36, 99%CI 1.36 to 3.80) and a nominally statistically significant relative risk for hypotension needing treatment of 1.27(95%CI 1.04 to 1.56, 99%CI 0.97 to 1.66). Conclusion: The evidence that perioperative βblockers reduce major cardiovascular events is encouraging but too unreliable to allow definitive conclusions to be drawn.

关键词：非心脏手术患者随机对照试验系统性回顾围手术期 β阻断剂荟萃分析致死性心肌梗死证据检索策略非致死性

他汀类药物和β阻断剂治疗与冠心病初始表现之间的关系

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世界核心医学期刊文摘（心脏病学分册） 2007年第11期3卷 2-页

作者： Go A.S. Iribarren C. Chandra M. 杜媛 Division of Research Kaiser Permanente of Northern California 2000 Broadway Street Oakland CA 94612-2304 United States Dr.

背景:冠状动脉粥样硬化可经数十年缓慢进展,但其常在临床上表现为突然的不稳定发作。表现为不稳定冠心病(如急性心肌梗死)的患者常与那些表现为相对稳定冠心病(如劳累型心绞痛)的患者有显著不同。

关键词：劳累型心绞痛 β阻断剂他汀类冠心病冠状动脉病药物

高血压系列问答(5) 如何正确评价和合理使用β阻断剂?

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中国临床医生杂志 2004年第6期32卷 50-50页

作者：胡大一同济大学医学院北京大学人民医院北京同仁医院

与美国高血压预防与治疗新指南(JNC)-6不同,美国新近公布的JNC-7未再把β阻断剂作为传统的降压药物与噻嗪类利尿剂并列为一线降压药物.近期公布结果的LIFI试验也显示在老年有左心室肥厚的高血压患者β阻断剂对于试验的主要终点心血管预... 详细信息

与美国高血压预防与治疗新指南(JNC)-6不同,美国新近公布的JNC-7未再把β阻断剂作为传统的降压药物与噻嗪类利尿剂并列为一线降压药物.近期公布结果的LIFI试验也显示在老年有左心室肥厚的高血压患者β阻断剂对于试验的主要终点心血管预后事件,主要是脑卒中的减少程度不如血管紧张素受体拮抗剂(ARB)氯沙坦,对左室肥厚的逆转程度也不如后者.加上在β阻断剂组新发生的糖尿病也多于ARB组,以及β阻断剂可能对血脂代谢的不良影响.目前我们应如何正确评价和合理使用β阻断剂?

关键词：高血压 β阻断剂合理用药预防治疗