Kaplan J A, Dunbar R W, Bland J W, Sumpter R, Jones E L
Anesth Analg. 1975 Sep-Oct;54(5):571-8. doi: 10.1213/00000539-197509000-00003.
Propranolol therapy has been implicated as a cause of myocardial depression and increased morbidity and mortality in patients undergoing coronary artery surgery. The authors reviewed 169 consecutive patients undergoing cardiac surgery, of whom 143 had been taking propranolol, with regard to preoperative administration of propranolol and intraoperative or postoperative complications. Patients taking propranolol until 24 hours before surgery showed no increased incidence of hypotension or bradycardia before cardiopulmonary bypass. Hypotension after bypass was no more common in patients off propranolol 12 to 48 hours than in patients who either discontinued the drug over 48 hours before operation or had never taken the drug. Myocardial contractility as measured by systolic time intervals was normal 24 to 48 hours after stopping propranolol therapy. Five patients had preoperative myocardial infarctions within 48 hours of discontinuing the drug. The operative mortality rate was 4 percent in patients taking propranolol within 48 hours of surgery and 6 percent in all other patients. Seven risk factors, other than propranolol, were identified in those patients requiring inotropic support. The authors conclude that propranolol can be given safely within 24 to 48 hours of coronary artery surgery provided the patient is a satisfactory candidate for myocardial revascularization.
普萘洛尔疗法被认为是冠状动脉手术患者发生心肌抑制以及发病率和死亡率增加的一个原因。作者回顾了169例连续接受心脏手术的患者，其中143例一直在服用普萘洛尔，研究了普萘洛尔的术前用药情况以及术中或术后并发症。术前一直服用普萘洛尔直至手术前24小时的患者，在体外循环前低血压或心动过缓的发生率并未增加。在术前12至48小时停用普萘洛尔的患者中，体外循环后低血压的情况并不比术前48小时以上停药或从未服用过该药物的患者更常见。停用普萘洛尔治疗24至48小时后，通过收缩期时间间期测量的心肌收缩力正常。有5例患者在停药后48小时内发生术前心肌梗死。手术时在术前48小时内服用普萘洛尔的患者手术死亡率为4%，其他所有患者的手术死亡率为6%。在那些需要使用正性肌力药物支持的患者中，除普萘洛尔外还确定了7个危险因素。作者得出结论，只要患者是心肌血运重建的合适人选，在冠状动脉手术前24至48小时内可以安全地给予普萘洛尔。
