Stone J G, Foëx P, Sear J W, Johnson L L, Khambatta H J, Triner L
Department of Anesthesiology, Columbia University, College of Physicians and Surgeons, New York, New York 10032.
Anesthesiology. 1988 Apr;68(4):495-500.
In a non-double-blind, prospective, randomized study, the intra-operative electrocardiograms of 128 mildly hypertensive surgical patients were examined in order to determine the incidence of myocardial ischemia during anesthesia. No patient had been receiving chronic antihypertensive therapy prior to the study, but a single small oral dose of a beta-adrenergic blocking agent (labetalol, atenolol, or oxprenolol) was given to 89 of them along with premedication. Forty-four per cent of the untreated control patients and 61% of the patients pretreated with a beta-adrenergic blocking agent had normal preoperative electrocardiograms and no risk factors for coronary artery disease other than hypertension (this difference between groups was not statistically significant). During tracheal intubation and/or emergence from anesthesia, a brief, self-limited episode of myocardial ischemia was detected in 11 of 39 untreated control patients, and in two of 89 patients pretreated with a beta-adrenergic blocking agent (P less than 0.001). Tachycardia always accompanied the ischemic events, but a conspicuous increase in blood pressure did not. The authors conclude that mild hypertension, when untreated prior to the induction of anesthesia, is associated with a high incidence of myocardial ischemia; and that a single small oral dose of a beta-adrenergic blocking agent, given with pre-medication, can significantly reduce that risk.
在一项非双盲、前瞻性、随机研究中，对128例轻度高血压手术患者的术中心电图进行了检查，以确定麻醉期间心肌缺血的发生率。在研究之前，没有患者接受过慢性抗高血压治疗，但其中89例患者在术前用药时服用了单次小剂量口服β-肾上腺素能阻滞剂（拉贝洛尔、阿替洛尔或氧烯洛尔）。44%的未治疗对照患者和61%接受β-肾上腺素能阻滞剂预处理的患者术前心电图正常，除高血压外无冠状动脉疾病危险因素（两组间差异无统计学意义）。在气管插管和/或麻醉苏醒期间，39例未治疗对照患者中有11例以及89例接受β-肾上腺素能阻滞剂预处理的患者中有2例检测到短暂的、自限性心肌缺血发作（P<0.001）。心动过速总是伴随缺血事件，但血压没有明显升高。作者得出结论，麻醉诱导前未治疗的轻度高血压与心肌缺血的高发生率相关；术前用药时服用单次小剂量口服β-肾上腺素能阻滞剂可显著降低该风险。
