不同劑量、劑型美托洛爾對急慢性房顫控制和術后房顫防治的衛生技術評估_《中國循證醫學雜志》

作者：

王浩 ,  董碧蓉 , 楊茗

四川大學華西醫院老年科（成都 610041）;

關鍵詞：

美托洛爾術后房顫慢性房顫劑量衛生技術評估

DOI：

10.7507/1672-2531.20080074

視頻：

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摘要 全文 圖表 視頻 參考文獻 施引文獻 補充材料

目的　對不同劑量、劑型的美托洛爾在控制慢性房顫快室率和預防術后房顫發生方面的療效和安全性進行評估。
方法　采用衛生技術評估方法，全面檢索PubMed（1966～2006）、EMbase（1980～2005）、Cochrane圖書館（2006年第3期）和中文生物醫學期刊數據庫，及各國心血管專業數據庫和不良反應中心等數據庫，依據納入和排除標準篩選文獻，評價納入文獻質量，并提取有效數據進行分析。
結果　針對慢性快室率房顫，靜脈注射美托洛爾10～15 mg能有效控制其快室率，但 lt;10 mg則不能達到最大療效，而 gt;15 mg臨床療效亦未見提高，且副作用有增加；口服美托洛爾100 mg/d較50 mg/?d在靜息和運動時對慢性房顫患者的心室率控制更好；預防術后房顫研究顯示，口服美托洛爾150 mg/d組術后房顫發生率和住院時間均較100 mg/d組有下降趨勢；靜注20 mg組及30 mg組術后房顫發生率顯著低于10 mg組；且靜滴美托洛爾與口服美托洛爾相比，術后48 h內房顫發生率明顯降低。各國藥物不良反應中心的數據顯示美托洛爾不良反應低。目前尚缺乏不同人種在劑量變化上的安全性研究。
結論　現有研究認為，大劑量美托洛爾的療效優于小劑量，但缺乏高質量證據，有待于針對性強的臨床試驗進一步證實。在安全性上兩者無差別。

引用本文： 王浩,董碧蓉,楊茗. 不同劑量、劑型美托洛爾對急慢性房顫控制和術后房顫防治的衛生技術評估. 中國循證醫學雜志, 2008, 08(5): 334-339. doi: 10.7507/1672-2531.20080074 復制

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12.	Booth JV, Ward EE, Colgan KC, et al. Metoprolol and Coronary Artery Bypass Grafting Surgery: Does Intraoperative Metoprolol Attenuate Acute β-Adrenergic Receptor Desensitization During Cardiac Surgery? Anesth Analg, 2004, 98(5): 1224-1231.
13.	Connolly SJ, Cybulsky I, Lamy A, et al. Double-blind, placebo-controlled, randomized trial of prophylactic metoprolol for reduction of hospital length of stay after heart surgery: the beta-Blocker Length Of Stay (BLOS) study. Am Heart J, 2003, 145(2): 226-232.
14.	Halonen J, Hakala T, Auvinen T, et al. Intravenous administration of metoprolol is more effective than oral administration in the prevention of atrial fibrillation after cardiac surgery. Circulation, 2006, 114(1 Suppl): I1-4.
15.	Möller B, Ringqvist C. Metoprolol in the treatment of supraventricular tachyarrhythmias. Ann Clin Res, 1979, 11(1): 34-41.
16.	Khalsa A, Edvardsson N, Olsson SB. Effects of metoprolol on heart rate in patients with digitalis treated chronic atrial fibrillation. Clin Cardiol, 1978, 1(2): 91-95.
17.	Metra M, Giubbini R, Nodari S, et al. Differential effects of beta-blockers in patients with heart failure: A prospective, randomized, double-blind comparison of the long-term effects of metoprolol versus carvedilol. Circulation, 2000, 102(5): 546-551.
18.	Pernat A, Pohar B, Horvat M. Heart conduction disturbances and cardiovascular collapse after disopyramide and low-dose metoprolol in a patient with hypertrophic obstructive cardiomyopathy. J Electrocardiol, 1997, 30(4): 341-344.
19.	Chen ZM, Pan HC, Chen YP, et al. Early intravenous then oral metoprolol in 45,852 patients with acute myocardial infarction: randomised placebo-controlled trial. Lancet, 2005, 366(9497): 1622-1632.

1. Sra J, Dhala A, Blanck Z, et al. Atrial fibrillation: epidemiology, mechanisms, and management. Curr Probl Cardiol, 2000, 25(7): 405-524.
2. Furberg CD, Psaty BM, Manolio TA, et al. Prevalence of atrial fibrillation in elderly subjects (the Cardiovascular Health Study). Am J Cardiol, 1994, 74(3): 236-241.
3. Stewart S, Hart CL, Hole DJ, et al. A population-based study of the long-term risks associated with atrial fibrillation: 20-year follow-up of the Renfrew/Paisley study. Am J Med, 2002, 113(5): 359-364.
4. Krahn AD, Manfreda J, Tate RB, et al. The natural history of atrial fibrillation: incidence, risk factors, and prognosis in the Manitoba Follow-Up Study. Am J Med, 1995, 98(5): 476-484.
5. Falk RH. Etiology and complications of atrial fibrillation: insights from pathology studies. Am J Cardiol, 1998, 82(8A): 10N-17N.
6. Crystal E, Grafinkle MS, Connolly SS, et al. Interventions for preventing postoperative atrial fibrillation in patients undergoing heart surgery. Cochrane Database Syst Rev, 2004: CD003611.
7. Moher D, Cook DJ, Eastwood S, et al. Improving the quality of reports of meta-analyses of randomised controlled trials: the QUOROM statement. Quality of Reporting of Meta-analyses. Lancet, 1999, 354(9193): 1896-1900.
8. Altman DG, Schulz KF, Moher D, et al. The revised CONSORT statement for reporting randomized trials: explanation and elaboration. Ann Intern Med, 2001, 134(8): 663-694.
9. Cochrane Deeks JJ, Dinnes J, D’Amico R, et al. Evaluating non-randomised intervention studies. Health Technol Assess, 2003, 7(27):iii-x, 1-173.
10. Helgerson, Steven D. MD, MPH; Holzman, Gregory S. MD, MPH Clinical Epidemiology: How to Do Clinical Practice Research. JAMA. 295(4):446, January 25, 2006. Wilkins, c2006.
11. Amsterdam EA, Kulcyski J, Ridgeway MG. Efficacy of cardioselective beta-adrenergic blockade with intravenously administered metoprolol in the treatment of supraventricular tachyarrhythmias. J Clin Pharmacol, 1991, 31(8): 714-718.
12. Booth JV, Ward EE, Colgan KC, et al. Metoprolol and Coronary Artery Bypass Grafting Surgery: Does Intraoperative Metoprolol Attenuate Acute β-Adrenergic Receptor Desensitization During Cardiac Surgery? Anesth Analg, 2004, 98(5): 1224-1231.
13. Connolly SJ, Cybulsky I, Lamy A, et al. Double-blind, placebo-controlled, randomized trial of prophylactic metoprolol for reduction of hospital length of stay after heart surgery: the beta-Blocker Length Of Stay (BLOS) study. Am Heart J, 2003, 145(2): 226-232.
14. Halonen J, Hakala T, Auvinen T, et al. Intravenous administration of metoprolol is more effective than oral administration in the prevention of atrial fibrillation after cardiac surgery. Circulation, 2006, 114(1 Suppl): I1-4.
15. Möller B, Ringqvist C. Metoprolol in the treatment of supraventricular tachyarrhythmias. Ann Clin Res, 1979, 11(1): 34-41.
16. Khalsa A, Edvardsson N, Olsson SB. Effects of metoprolol on heart rate in patients with digitalis treated chronic atrial fibrillation. Clin Cardiol, 1978, 1(2): 91-95.
17. Metra M, Giubbini R, Nodari S, et al. Differential effects of beta-blockers in patients with heart failure: A prospective, randomized, double-blind comparison of the long-term effects of metoprolol versus carvedilol. Circulation, 2000, 102(5): 546-551.
18. Pernat A, Pohar B, Horvat M. Heart conduction disturbances and cardiovascular collapse after disopyramide and low-dose metoprolol in a patient with hypertrophic obstructive cardiomyopathy. J Electrocardiol, 1997, 30(4): 341-344.
19. Chen ZM, Pan HC, Chen YP, et al. Early intravenous then oral metoprolol in 45,852 patients with acute myocardial infarction: randomised placebo-controlled trial. Lancet, 2005, 366(9497): 1622-1632.

《中國循證醫學雜志》

不同劑量、劑型美托洛爾對急慢性房顫控制和術后房顫防治的衛生技術評估

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《中國循證醫學雜志》

不同劑量、劑型美托洛爾對急慢性房顫控制和術后房顫防治的衛生技術評估

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