不同剂量、剂型美托洛尔对急慢性房颤控制和术后房颤防治的卫生技术评估_《中国循证医学杂志》

作者：

王浩 ,  董碧蓉 , 杨茗

四川大学华西医院老年科（成都 610041）;

关键词：

美托洛尔术后房颤慢性房颤剂量卫生技术评估

DOI：

10.7507/1672-2531.20080074

视频：

导出 下载 收藏 扫码 引用

摘要 全文 图表 视频 参考文献 施引文献 补充材料

目的　对不同剂量、剂型的美托洛尔在控制慢性房颤快室率和预防术后房颤发生方面的疗效和安全性进行评估。
方法　采用卫生技术评估方法，全面检索PubMed（1966～2006）、EMbase（1980～2005）、Cochrane图书馆（2006年第3期）和中文生物医学期刊数据库，及各国心血管专业数据库和不良反应中心等数据库，依据纳入和排除标准筛选文献，评价纳入文献质量，并提取有效数据进行分析。
结果　针对慢性快室率房颤，静脉注射美托洛尔10～15 mg能有效控制其快室率，但 lt;10 mg则不能达到最大疗效，而 gt;15 mg临床疗效亦未见提高，且副作用有增加；口服美托洛尔100 mg/d较50 mg/?d在静息和运动时对慢性房颤患者的心室率控制更好；预防术后房颤研究显示，口服美托洛尔150 mg/d组术后房颤发生率和住院时间均较100 mg/d组有下降趋势；静注20 mg组及30 mg组术后房颤发生率显著低于10 mg组；且静滴美托洛尔与口服美托洛尔相比，术后48 h内房颤发生率明显降低。各国药物不良反应中心的数据显示美托洛尔不良反应低。目前尚缺乏不同人种在剂量变化上的安全性研究。
结论　现有研究认为，大剂量美托洛尔的疗效优于小剂量，但缺乏高质量证据，有待于针对性强的临床试验进一步证实。在安全性上两者无差别。

引用本文： 王浩,董碧蓉,杨茗. 不同剂量、剂型美托洛尔对急慢性房颤控制和术后房颤防治的卫生技术评估. 中国循证医学杂志, 2008, 08(5): 334-339. doi: 10.7507/1672-2531.20080074 复制

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.

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.

《中国循证医学杂志》

不同剂量、剂型美托洛尔对急慢性房颤控制和术后房颤防治的卫生技术评估

摘要 全文 图表 视频 参考文献 施引文献 补充材料

上一篇

下一篇

Format

Content

《中国循证医学杂志》

不同剂量、剂型美托洛尔对急慢性房颤控制和术后房颤防治的卫生技术评估

摘要 全文 图表 视频 参考文献 施引文献 补充材料

上一篇

下一篇

Format

Content

摘要全文图表视频参考文献施引文献补充材料