Dagnino J, Prys-Roberts C
Anesth Analg. 1985 Mar;64(3):305-11.
Patients with hypertension or ischemic heart disease are often treated with beta-adrenoceptor antagonists, yet the degree of beta-adrenoceptor blockade has rarely been studied in relation to anesthesia. We have constructed isoproterenol dose-response curves in four groups of patients under general anesthesia: group I, 27 elderly normotensive patients not receiving drugs; group II, 14 hypertensive patients treated with cardioselective beta-adrenoceptor antagonists; group III, 15 hypertensive patients receiving nonselective beta-adrenoceptor antagonists; group IV, 13 patients receiving an infusion of labetalol at 0.15 mg X kg-1 X hr-1. Geometric mean CD25, the dose of isoproterenol required to increase the heart rate by 25 beats/min was 4.4 micrograms (3.5-5.6, 95% confidence interval (CI) of the mean) in group I, and 27 micrograms (19-38, 95% CI), 39 micrograms (29-52, 95% CI), and 95 micrograms (62-147, 95% CI) in groups II, III, and IV, respectively. All differences were significant (P less than 0.01), except those between groups II and III (P less than 0.1). No signs of myocardial ischemia and only a few transient arrhythmias were observed. Isoproterenol dose-response curves are a safe means to assess the degree of beta-adrenoceptor blockade during anesthesia and the postoperative period.
高血压或缺血性心脏病患者常接受β-肾上腺素能受体拮抗剂治疗，但β-肾上腺素能受体阻滞程度与麻醉相关的研究却很少。我们在全身麻醉下构建了四组患者的异丙肾上腺素剂量-反应曲线：第一组，27名未接受药物治疗的老年血压正常患者；第二组，14名接受心脏选择性β-肾上腺素能受体拮抗剂治疗的高血压患者；第三组，15名接受非选择性β-肾上腺素能受体拮抗剂治疗的高血压患者；第四组，13名以0.15 mg·kg-1·hr-1输注拉贝洛尔的患者。几何平均CD25，即心率增加25次/分钟所需的异丙肾上腺素剂量，在第一组中为4.4微克（均值的95%置信区间[CI]为3.5 - 5.6），在第二、三、四组中分别为27微克（19 - 38，95%CI）、39微克（29 - 52，95%CI）和95微克（62 - 147，95%CI）。除第二组和第三组之间差异不显著（P < 0.1）外，所有差异均具有统计学意义（P < 0.01）。未观察到心肌缺血迹象，仅出现少数短暂性心律失常。异丙肾上腺素剂量-反应曲线是评估麻醉期间和术后β-肾上腺素能受体阻滞程度的一种安全方法。
