Tight Heart Rate Control Is The Prerequisite And Foundation For Perioperative Myocardial Protection

Objective:To systematically review the the influence of tight HR control on the efficacy of perioperativeβ-blockade, and discuss the effective measures of perioperative myocardial protection. Methods:We searched the PubMed, OVID, EMBASE, Cochrane Library and Chinese Biomedical Database(CBM)for studies on trials evaluating perioperative (3-blockers after noncardiac surgery. The quality of the studies Wag evaluated by the method recommended by Cochrane Collabomtion. Meta-analysis Wag conducted using the Cochnme Collaboration's RevMan software. Results:This search yielded 13 trials with 11590 patients. The combined results of all studies show cardioprotective effect ofβ-blockers[P=0.0001, OR=0.64,95%CI=0.50-0.80], with considerable heterogeneity among the studies(I2=57%). However, grouping the trials on the basis of maximal HR showed that trials where the estimated maximal HR was 100 bpm were associated with cardioprotection[p<0.00001, OR=0.37,95%CI=0.26-0.52] whereas trials where the estimated maximal HR was 100 bpm did not demonstrate cardioprotection[p=.48, OR=1.13,95%CI=0.81-1.59]with no heterogeneity (I2=0%). Conclusion:The trials suggesting that effective control of HR is important for achieving cardioprotection, and demonstrates that administration ofβ-blockers does not reliably decrease HRs in all patients, judicious use of combination therapy with other drugs may be necessary to achieve effective postoperative control of HR.