Cost-effectiveness of amiodarone for prophylaxis of atrial fibrillation after cardiothoracic surgery

STUDY OBJECTIVE: To determine whether prophylactic amiodarone, dosed according to Atrial Fibrillation Suppression Trial (AFIST) I and II regimens, is a cost-effective strategy for prevention of postoperative atrial fibrillation. DESIGN: Cost-effectiveness analysis of retrospective cohort study. SETTING: Urban, academic hospital. PATIENTS: A total of 2046 patients who underwent cardiothoracic surgery between February 1, 1998, and October 31, 2003. Of these patients, 186 received amiodarone and 1860 served as controls. MEASUREMENTS AND MAIN RESULTS: Each patient who received prophylactic amiodarone using the AFIST I or II dosing strategies was matched for age, sex, history of valvular surgery, history of atrial fibrillation, beta-blocker intolerance, and receipt of preoperative digoxin therapy with 10 patients who did not receive prophylactic amiodarone. Occurrence of postoperative atrial fibrillation, total hospital costs, and both intensive care unit (ICU) and total hospital length of stay (LOS) were compared between groups. Nonparametric bootstrapping was conducted to examine study results as part of a quadrant analysis and to calculate confidence intervals for the incremental cost-effectiveness ratio. The ICU and total hospital LOS, and total costs for patients with and without postoperative atrial fibrillation were also compared. Fewer patients receiving prophylactic amiodarone developed postoperative atrial fibrillation compared with controls (23.1% vs 29.9%, p=0.05). Total hospital costs for the amiodarone group were 28% less than those for the control group (24,131 US dollars +/- 26,539 vs 33,518 US dollars +/- 40,892, p=0.002). Approximately 98% of the time, patients receiving amiodarone prophylaxis fell into the quadrant that showed superior efficacy and lower total costs. Patients who developed postoperative atrial fibrillation, compared with those who did not, regardless of amiodarone prophylaxis, had a longer mean +/- SD stay in the ICU (6.9 +/- 17.1 vs 3.7 +/- 7.9 days, p<0.001), a longer mean total hospital LOS (14.8 +/- 18.8 vs 10.2 +/- 10.4 days, p+/-0.001), and higher mean total hospital costs (41,574 US dollars +/- 54,721 vs 28,968 US dollars +/- 31,046, p<0.001). CONCLUSION: Prophylactic amiodarone was shown to reduce the occurrence of postoperative atrial fibrillation as well as total hospital costs in patients undergoing cardiothoracic surgery. In patients who developed postoperative atrial fibrillation, both ICU and total hospital LOS as well as total hospital costs were increased.     

Esmolol versus diltiazem in atrial fibrillation following coronary artery bypass graft surgery

PURPOSE: Atrial fibrillation (AF) is the most common arrhythmic complication following coronary artery bypass graft surgery (CABG). The efficacy and safety of esmolol and diltiazem were compared in patients with post-CABG AF. METHODS: This study was a retrospective medical record review of consecutive patients with post-CABG AF > or =15 min in duration with a ventricular rate > or =110 b.p.m. who received either i.v. esmolol (n = 59) or i.v. diltiazem (n = 48) with or without concomitant digoxin therapy at a single university-affiliated teaching hospital. Treatment success was defined as either cardioversion to sinus rhythm or a reduction in the ventricular rate to < or =90 b.p.m. at 24 h after the start of therapy. Time to treatment success and the occurrence of adverse effects were considered secondary outcomes. RESULTS: A total of 107 patients with post-CABG AF were treated with i.v. esmolol (n = 59) or i.v. diltiazem (n = 48). The mean maximum dose of esmolol and diltiazem were 115 +/- 38 microg/kg/min and 11.2 +/- 3.5 mg/h, respectively. The average duration of the esmolol and diltiazem infusions were 19.3 +/- 8.5 h and 20.1 +/- 11.3 h, respectively. Based on the combined efficacy endpoint of cardioversion or ventricular rate control, esmolol was significantly more effective than diltiazem (90% vs 77%; p = 0.038). Time to treatment success was significantly better for esmolol than diltiazem at all time points (1, 2, 4, 6, 12, and 24 h post-treatment). The overall incidence of adverse effects was 44% with esmolol and 60% with diltiazem (p = 0.04). Rates of drug discontinuance for adverse effects were significantly less for esmolol (20%) compared with diltiazem (38%) (p = 0.04). CONCLUSIONS: Esmolol is significantly more effective than diltiazem in the management of post-CABG AF. More patients converted to sinus rhythm with esmolol as compared to diltiazem. Esmolol was associated with fewer adverse effects than diltiazem, including adverse effects leading to drug discontinuance. Due to study design limitations (retrospective data collection), an adequately powered randomised, controlled trial is needed to confirm these preliminary findings.     

Esmolol versus diltiazem in atrial fibrillation following coronary artery bypass graft surgery

SUMMARY

Purpose: Atrial fibrillation (AF) is the most common arrhythmic complication following coronary artery bypass graft surgery (CABG). The efficacy and safety of esmolol and diltiazem were compared in patients with post-CABG AF.

Methods: This study was a retrospective medical record review of consecutive patients with post-CABG AF >15?min in duration with a ventricular rate >110?b.p.m. who received either i.v. esmolol (n?=?59) or i.v. diltiazem (n?=?48) with or without concomitant digoxin therapy at a single university-affiliated teaching hospital. Treatment success was defined as either cardioversion to sinus rhythm or a reduction in the ventricular rate to <90?b.p.m. at 24?h after the start of therapy. Time to treatment success and the occurrence of adverse effects were considered secondary outcomes.

Results: A total of 107 patients with post-CABG AF were treated with i.v. esmolol (n?=?59) or i.v. diltiazem (n?=?48). The mean maximum dose of esmolol and diltiazem were 115?±?38?μg/kg/min and 11.2?±?3.5?mg/h, respectively. The average duration of the esmolol and diltiazem infusions were 19.3?±?8.5?h and 20.1?±?11.3?h, respectively. Based on the combined efficacy endpoint of cardioversion or ventricular rate control, esmolol was significantly more effective than diltiazem (90% vs 77%; p?=?0.038). Time to treatment success was significantly better for esmolol than diltiazem at all time points (1, 2,4,6,12, and 24?h post-treatment). The overall incidence of adverse effects was 44% with esmolol and 60% with diltiazem (p?=?0.04). Rates of drug discontinuance for adverse effects were significantly less for esmolol (20%) compared with diltiazem (38%) (p?=?0.04).

Conclusions: Esmolol is significantly more effective than diltiazem in the management of post-CABG AF. More patients converted to sinus rhythm with esmolol as compared to diltiazem. Esmolol was associated with fewer adverse effects than diltiazem, including adverse effects leading to drug discontinuance. Due to study design limitations (retrospective data collection), an adequately powered randomised, controlled trial is needed to confirm these preliminary findings.     

Digoxin prophylaxis following coronary artery bypass surgery

The effect of the postoperative administration of digoxin to patients undergoing coronary artery bypass surgery on the incidence of supraventricular arrhythmias was studied. Patients were randomly assigned to a control group (n = 51) or digoxin group (n = 47) on a prospective basis. Patient characteristics were similar in both groups, and no patients were receiving digoxin therapy preoperatively or other antiarrhythmic medications. All patients had normal systolic ejection fractions, renal function, and hepatic function. Eight patients (16%) in the control group developed postoperative arrhythmias while seven patients (15%) in the digoxin group developed supraventricular arrhythmias. This difference was not significant. Two patients in the digoxin group developed digoxin-induced arrhythmias, and two other patients experienced digoxin-related nausea and vomiting, which were resolved with discontinuation of the drug. The postoperative administration of digoxin to patients undergoing coronary artery bypass surgery had no effect on the incidence of supraventricular arrhythmias. The prophylactic use of digoxin therapy in this patient population is not recommended unless there is a history of arrhythmias responsive to digoxin therapy.     

冠状动脉旁路移植术后早期心房颤动的相关因素分析

目的分析冠状动脉旁路移植（CABG）术后早期心房颤动（AF）发生的相关因素,为探讨其相应的防治措施提供依据。方法回顾性总结2002年3月至2007年10月间住院手术治疗的单纯CABG病例101例,按术后有否发生AF进行分组,并分别对术前、术中和术后资料进行统计和分析。统计学分析采用独立样本t检验和χ2检验。结果 CABG术后早期AF的发生率为21.8%（22/101）,两组比较,AF组平均年龄、体外循环时间和主动脉阻断时间、辅助呼吸时间、术后胸腔引流总量均明显大于非AF组,有显著性差异（P〈0.05）;RCA近-中段狭窄〉50%的患者AF的发生率高达81.8%。性别、心肌梗死史、高血压病史、糖尿病史、LVEF大小和应用洋地黄类药物与否在两组间无统计学意义（P〉0.05）。结论 CABG术后AF的发生率为21.8%,77.3%发生在术后1～3d内。CABG术后AF是多因素造成的,其中一些重要的因素包括：年龄、体外循环时间、辅助呼吸时间、术后胸腔引流总量。RCA近-中段狭窄〉50%为独立危险因素。术前存在AF的患者术后依旧存在AF。采用OPCAB手术方式的患者术后AF的发生率低于CCABG。     

胺碘酮治疗急性冠脉综合征伴快速房颤临床分析

目的 观察静脉滴注胺碘酮在急性冠状动脉综合征(ACS)伴快速房颤患者的临床疗效。方法 20例ACS患者伴新近发生快速房颤,静脉应用胺碘酮,先静脉注射负荷量后,继以静脉滴注维持观察房颤转复及心室率控制及不良反应。结果 20例患者心率用药后较用药前明显下降(P<0.01)。其中14例患者(70%)在24 h内转为窦性心律,3例用药后出现长R-R间期,3例出现窦性心动过缓,经停药或减药后恢复。结论静脉应用胺碘酮治疗ACS伴快速房颤是有效及安全的。     

Magnesium sulfate for prevention of postoperative atrial fibrillation in patients undergoing coronary artery bypass grafting.

PURPOSE: The effects of i.v. magnesium sulfate on the frequency of postoperative atrial fibrillation (AF) in patients undergoing coronary artery bypass grafting (CABG) and on the frequency of AF at hospital discharge were studied. The effect of postoperative AF on hospital length of stay (LOS) was also assessed. METHODS: A retrospective chart review was performed for all patients who underwent CABG surgery by a single surgeon during 2000-2001 at a community medical center. Patients were eligible for inclusion if they had first-time CABG surgery. Patients who underwent CABG surgery in 2000 did not receive magnesium sulfate and served as controls for the study. Patients were included in the magnesium group if they received 2 g of i.v. magnesium sulfate intraoperatively and 2 g every 12 hours postoperatively for at least two consecutive days. RESULTS: A total of 262 patients underwent CABG during the study period, and 28 were excluded from the study. Of the remaining 234 patients, 99 were in the magnesium group, and 135 were in the control group. No significant differences were found between the study groups in recorded demographic characteristics. Postoperative AF occurred significantly less frequently in the magnesium group (p = 0.038). There was no significant difference between treatment groups in the number of patients discharged in AF (p = 0.307). Among all patients, those with AF were significantly more likely to have a prolonged LOS (p = 0.036). CONCLUSION: CABG patients who received intraoperative and postoperative i.v. magnesium sulfate had a significantly lower rate of AF compared with patients who did not receive the drug. The number of patients discharged with AF was not affected by magnesium administration. AF was associated with a higher likelihood of prolonged postoperative hospitalization.     

卡维地洛与美托洛尔预防冠脉搭桥术后房颤的疗效比较

目的观察卡维地洛与美托洛尔在冠脉搭桥术后预防房颤的疗效。方法接受冠脉搭桥术的患者共200例,随机分成2组,每组100例,分别给予卡维地洛和美托洛尔治疗。所有患者于术前3 d开始接受药物。美托洛尔组起始剂量50 mg,每日2次;卡维地洛组起始剂量12.5 mg,每日2次。药物的剂量依患者的血流动力学反应进行调整,一直监测到术后第3天。结果美托洛尔组43例(43%)发生房颤,卡维地洛组20例(20%)发生房颤,两组比较,差异有统计学意义(P=0.001)。结论卡维地洛预防冠脉搭桥术后早期房颤的效果优于美托洛尔。     

伊布利特与胺碘酮治疗心房颤动的Meta-分析

目的 系统评价伊布利特与胺碘酮治疗心房颤动的有效性与安全性。方法 检索中国学术期刊全文数据库（CNKI）、中国生物医学文献数据库（CBM）、维普中文期刊全文数据库（VIP）、万方数据库、PubMed、Embase和Cochrane Library,检索时间均为建库至2019年6月。纳入伊布利特与胺碘酮比较治疗房颤的随机对照试验（RCTs）,由两名研究员独立筛选并提取资料,采用Cochrane标准进行评价,运用RevMan 5.3软件进行Meta-分析。结果 最终纳入18篇RCTs进行Meta-分析,结果显示伊布利特组较胺碘酮组治疗房颤的有效性（OR=2.65,95% CI=2.03～3.46,P<0.000 01）、房颤转复时间（WMD=-21.54,95% CI=-24.73～-18.34,P<0.000 01）均优于胺碘酮组;两组治疗房颤安全性比较差异无统计学意义（RR=0.74, 95% CI=0.46～1.18, P=0.20）,但胺碘酮组不良反应发生率（18.36%）稍高于伊布利特组（16.18%）。结论 伊布利特对房颤转复的有效率显著高于胺碘酮,转复时间亦较胺碘酮短,在安全性方面二者无显著差异。由于纳入样本量较少,以后研究中仍需大样本、高质量的RCT进一步确认以期得到可靠的结果。     

比索洛尔和胺碘酮治疗房颤比较

目的：探讨比索洛尔和胺碘酮治疗心房颤动的疗效和不良反应。方法：回顾性分析本院2010年5月～2011年3月收治的确诊为非瓣膜性心房颤动患者90例的临床资料,将其随机分为比索洛尔组（A组）45例、胺碘酮组（B组）45例。分别应用比索洛尔（5~10mg/d）和胺碘酮（200~400mg/d）,治疗4周,疗效达到即可,未达到疗效者剂量加倍,再治疗4周即结束。观察两组的疗效和不良反应。结果：A组和B组转律率差异无统计学意义（P〉0.05）。A组心室率控制率明显大于B组（P〈0.01）。A组治疗无效率明显低于B组（P〈0.01）。A组症状改善率明显高于B组（P〈0.01）。两组不良反应比较B组明显多于A组（P〈0.01）。结论：比索洛尔优于胺碘酮,可作为治疗房颤的一线药物。     

术前血浆磷脂转运蛋白水平与冠状动脉旁路移植术后 新发心房颤动的相关性

目的 探讨术前血浆磷脂转运蛋白(PLTP)水平与冠状动脉旁路移植术(CABG)后新发房颤(POAF)的相关性及其诊断价值。方法 自2015年1月至2016年6月,在中国医学科学院北京协和医学院泰达国际心血管病医院就诊并接受单独CABG手术的所有病人中,选取40例发生POAF的病人为AF组,未发生POAF的病人40例,为SR组。测量两组病人术前血浆中PLTP水平,评价其与POAF的相关性与其对POAF的诊断价值。结果 AF组PLTP水平(1.5±1.5) mg/mL显著低于SR组 (2.6±1.6) mg/mL(P=0.004);在矫正POAF发生的相关变量后,PLTP仍与POAF独立相关;ROC分析显示PLTP诊断POAF的曲线下面积(AUC)为0.74(P<0.001),其临界值为0.43 mg/mL。结论 发生CABG术后POAF的病人血浆中PLTP水平较未发生病人为低;术前血浆中PLTP水平与CABG术后POAF的发生独立相关,且可能为POAF发生的可靠预测指标。     

An economic analysis of amiodarone versus placebo for the prevention of atrial fibrillation after open heart surgery.

STUDY OBJECTIVE: To determine if the additional costs of oral amiodarone in patients undergoing open heart surgery would be offset by reductions in the frequency of atrial fibrillation. DESIGN: Piggyback cost analysis of the data from a randomized, double-blind, placebo-controlled trial. SETTING: Urban academic hospital. PATIENTS: Two hundred twenty elderly patients (> or = 60 yrs old) undergoing open heart surgery. INTERVENTION: Hospital costs of open heart surgery in patients given amiodarone for the prevention of atrial fibrillation and in prespecified subgroups were compared with those for patients given placebo (i.e., standard care with beta-blockers alone). MEASUREMENTS AND MAIN RESULTS: Total hospital costs incurred were $15,565 +/- $9832 and $16,126 +/- $8043 in the amiodarone and placebo groups, respectively (p=0.12). General ward, intensive care unit, operating room, pharmacy, and costs in all other departments were similar between the groups (p>0.05 for all comparisons). Because costs were similar but amiodarone was more effective than placebo, amiodarone was cost-effective compared with placebo. Amiodarone remained cost-effective compared with placebo regardless of the following subgroup characteristics: rapid or slow loading strategy, no history of atrial fibrillation or heart failure, age older than 70 years, and no tolerance to preoperative beta-blockers. Moreover, in the one-way sensitivity analysis, the findings remained robust to changes in effectiveness and cost of amiodarone. CONCLUSION: Routine prophylaxis with amiodarone is cost-effective compared with placebo. Future studies should examine the cost-effectiveness of selective prophylaxis, and primary cost-effectiveness studies should be conducted to validate these findings.     

NLR联合hs-cTnT对非体外循环冠状动脉旁路移植术后心房颤动的预测价值

摘要：目的　探讨中性粒细胞与淋巴细胞比值（NLR）联合高敏心肌肌钙蛋白T（hs-cTnT）对非体外循环冠状动脉旁路移植术（OPCAB）后心房颤动（AF）的预测价值。方法　选取2017年1月—2019年6月在我院接受OPCAB治疗的冠心病患者108例,根据患者术后是否发生AF分为AF组（32例）和非AF组（76例）,比较2组一般资料、心功能、OPCAB围术期指标、NLR、hs-cTnT的变化,多因素Logistic回归分析OPCAB后发生AF的危险因素,受试者工作特征（ROC）曲线分析NLR、hs-cTnT对OPCAB后AF的预测价值。结果　AF组患者的年龄、NYHA心功能分级≥Ⅲ级比例、左心房内径（LAD）、NLR、hs-cTnT、机械通气时间均高于非AF组（P＜0.05）。LAD（OR=3.032,95%CI：1.614～5.696）、NLR（OR=2.186,95%CI：1.171～4.081）、hs-cTnT（OR=2.284,95%CI：1.313～3.973）升高均是OPCAB后AF的独立危险因素（P＜0.05）。ROC分析结果显示,NLR和hs-cTnT对OPCAB后AF的预测价值均较高,曲线下面积分别为0.781（95%CI：0.685~0.877）、0.764（95%CI：0.663~0.866）,最佳临界值分别为3.52、13.08 ng/L;而两者联合分析可使得预测价值进一步提升,曲线下面积为0.846（95%CI：0.767~0.925）。结论　NLR联合hs-cTnT对OPCAB后AF的预测效能较高,具有一定的临床应用价值。     

非体外循环冠状动脉搭桥术的麻醉处理

目的　探讨非体外循环冠脉搭桥术的麻醉处理。方法　对 8例冠心病患者行非体外循环冠脉搭桥术 ,麻醉诱导用咪唑安定、芬太尼、利多卡因和司可林。用异丙酚、芬太尼、安氟醚和万可松维持麻醉。手术期间静脉持续输注硝酸甘油。术中监测血流动力学和 ECG、Sp O2 。结果　 8例患者血流动力学稳定 ,无 1例改行体外循环。平均手术时间 (118.75± 18.85 ) min,术后拔管时间 (8.93± 4 .94 ) h。结论　非体外循环冠脉搭桥术采用平衡麻醉和静吸复合麻醉 ,麻醉处理的关键在于术中维持血流动力学稳定和维持心肌氧的供需平衡     

比索洛尔和胺碘酮治疗房颤的临床疗效

目的 观察记录比索洛尔和胺碘酮治疗心房颤动的临床疗效.方法 分别应用比索洛尔和胺碘酮来治疗房颤;按其药物的使用情况分为比索洛尔组和胺碘酮组.观察两组患者房颤转复前后心室率和血压的变化情况、房颤转复的时间和药物的不良反应,并将两组进行对比分析.结果 两组治疗房颤的转复成功率比较差异无显著性（P〉0.05）;平均转复时间、用药后心室率和血压降低情况的比较,两组也不存在显著差异（P〉0.05）.结论 无论应用比索洛尔还是胺碘酮治疗房颤,均有较高的转复成功率、显著缩短的转复时间以及有效的心室率控制,都可以作为临床上治疗房颤的一线药物.     

伊布利特联合阿托伐他汀对冠状动脉搭桥围术期房颤的预防效果

目的 探讨伊布利特联合阿托伐他汀对冠状动脉搭桥围术期房颤的预防作用。方法 回顾性分析2020年1月—2020年12月在安徽省立医院接受治疗的148例施行冠状动脉搭桥术的冠心病患者,根据不同治疗方式分为对照组（n＝73）和试验组（n＝75）。两组患者施行冠状动脉搭桥术后均常规给予阿司匹林、酒石酸美托洛尔等常规药物治疗。对照组术前7 d及术后第2天给予阿托伐他汀钙片口服,每次20 mg,每晚1次。试验组在对照组的基础上于术后第2天加用富马酸伊布利特注射液,1 mg加0.9%氯化钠注射液20 mL,10 min内静脉推注给药。静推过程中若患者转为窦性心律,则停止推注。静推后10 min若患者仍未转复为窦性心律,则间隔30 min再次给予富马酸伊布利特注射液1 mg,若仍房颤,则镇静后,给予200 J同步直流电复律。两组术后均常规抗凝,疗程7 d。术后7 d比较两组患者的临床疗效、术后房颤发生情况,分别于给药前、第1次给药后30 min及第1次给药后24 h测定患者左心房内径、血清肌钙蛋白I（CTnI）、P波离散度,观察治疗期间两组患者不良反应发生情况。结果 治疗后,试验组总有效率为93.33%,显著高于对照组的73.97%,两组比较差异有统计学意义（P<0.05）。两组术后房颤起始时间比较差异无统计学意义（P>0.05）;试验组最大心室率、单次房颤持续时间均显著低于对照组,差异有统计学意义（P<0.05）。治疗前,两组左心房内径、CTnI水平比较差异无统计学意义（P>0.05）;第1次给药后30 min,两组左心房内径、CTnI水平均显著升高（P<0.05）,但两组左心房内径、CTnI水平比较差异无统计学意义（P>0.05）;第1次给药后24 h,两组左心房内径、CTnI水平均低于治疗前（P<0.05）,试验组恢复程度优于对照组,差异有统计学意义（P<0.05）。治疗前,两组P波最大值、P波宽度水平比较差异无统计学意义（P>0.05）;第1次给药后30 min,两组P波最大值、P波宽度水平均显著升高（P<0.05）,但两组P波最大值、P波宽度水平比较差异无统计学意义（P>0.05）;第1次给药后24 h,两组P波最大值、P波宽度水平均低于治疗前（P<0.05）,试验组恢复效果优于对照组,差异有统计学意义（P<0.05）。两组用药期间不良反应发生情况差异无统计学意义（P>0.05）。结论 伊布利特联合阿托伐他汀可有效预防冠脉搭桥术后房颤的发生,可有效控制心房内径增大,延缓心肌重构。     

Does coronary artery bypass surgery affect metoprolol bioavailability

Background

β-blockers are commonly administered in patients with coronary artery bypass surgery (CABG). Despite this therapy, however, the incidence of postoperative atrial fibrillation (AF) is high (9–19%), and it is unknown why the β-blockers do not reduce the incidence of AF more efficiently. In this pharmacokinetics study, in which the patients acted as their own controls, we have evaluated the bioavailability of perioperative metoprolol tablets in CABG surgery patients.

Methods

Twelve male patients, aged 45–64 years, scheduled for CABG surgery were administered an initial 50 mg metoprolol tartrate tablet orally on the morning of the preoperative day and thereafter at 12-h intervals. Regular blood samples were collected up to 12 h after the first administration of the drug on the preoperative day as well on the first and third postoperative days. The plasma concentration for metoprolol was analyzed (limit of quantification = 0.001 mg/L) using liquid chromatography-tandem mass spectrometry.

Results

The bioavailability of the metoprolol was significantly less on the first postoperative day, with AUC_0–12 values ranging from 0.7 to 17.1 (median: 7.2) mg min/L, than on the preoperative day, with AUC_0–12 values of 5.1–26.7 (12.6) mg min/L; however, it returned to the preoperative values on the third postoperative day, with AUC_0–12 values of 3.5–25.2 (15.2) mg min/L. Similar changes were observed in C_max values: preoperative C_max ranged between 0.026 and 0.123 (0.060) mg/L, on the first postoperative day, the C_max ranged between 0.003 and 0.093 (0.025) mg/L, and on the third postoperative day, the C_max ranged between 0.009 and 0.136 (0.061) mg/L. There was no correlation between the pharmacokinetic parameters and patient characteristics, but both the preoperative C_max and C₆₀ correlated significantly with the postoperative C_max (Pearson correlation coefficient: 0.61–0.72). One patient with one of the lowest rates and extent of metoprolol absorption developed AF.

Conclusion

This study indicates that the bioavailability of metoprolol is markedly reduced when administered in tablet form during the early phase after CABG.

     

不同旁路材料在冠状动脉旁路移植术中的应用

目的总结冠状动脉旁路移植术中目前几种常用旁路材料的临床应用。方法2001-10～2006-10连续106例行冠状动脉旁路移植术,旁路材料包括左乳内动脉(106根)、游离右乳内动脉(42根)、桡动脉(46根)和大隐静脉(86根),回顾分析不同旁路材料的手术结果。结果全组无手术死亡,桡动脉移植后旁路血管“线样征”1例;无胸骨、前臂并发症;下肢切口感染2例,均为糖尿病、大体重患者,治疗后痊愈。结论注意旁路材料的取制技巧,针对不同病变冠脉血管选取应用不同旁路血管,以及术后及时监护处理是保证良好手术结果的关键。