Boudoulas H, Snyder G L, Lewis R P, Kates R E, Karayannacos P E, Vasko J S
Ann Thorac Surg. 1978 Sep;26(3):222-7. doi: 10.1016/s0003-4975(10)63674-0.
Thirty consecutive patients undergoing coronary bypass were studied. Oral propranolol therapy was maintained up to 4 to 10 hours before operation. Nineteen of the patients had a history of myocardial infarction (MI), 14 had hypoakinetic areas, and 8 had decreased ejection fraction indicating advanced coronary artery disease. Twenty-four-hour urinary epinephrine and norepinephrine obtained the day before operation were markedly increased at 136 +/- 12 microgram per 24 hours (normal, 39 +/- 4 microgram, rho less than 0.01). There were 4 perioperative MIs (13%) and no deaths. Plasma propranolol 1 hour before operation was 43.3 +/- 8 ng per milliliter, indicating good beta blockade. Propranolol was started within 24 hours postoperatively. There were no preoperative, intraoperative, or postoperative complications related to propranolol therapy. We conclude that because of markedly increased adrenergic tone the day before operation and transient hypersensitivity to adrenergic stimulation after withdrawal of propranolol, this agent should be continued through coronary bypass operation.
对30例连续接受冠状动脉搭桥手术的患者进行了研究。术前口服普萘洛尔治疗持续4至10小时。19例患者有心肌梗死（MI）病史，14例有运动减弱区域，8例射血分数降低，提示存在严重冠状动脉疾病。术前一天测得的24小时尿肾上腺素和去甲肾上腺素明显升高，为136±12微克/24小时（正常为39±4微克，P＜0.01）。围手术期发生4例心肌梗死（13%），无死亡病例。术前1小时血浆普萘洛尔浓度为43.3±8纳克/毫升，表明β受体阻滞良好。术后24小时内开始使用普萘洛尔。未发生与普萘洛尔治疗相关的术前、术中和术后并发症。我们得出结论，由于术前一天肾上腺素能张力明显增加以及停用普萘洛尔后对肾上腺素能刺激的短暂超敏反应，该药物应持续至冠状动脉搭桥手术结束。
