Bojar R M, Weiner B, Cleveland R J
Department of Cardiothoracic Surgery, New England Medical Center Hospitals, Boston, Massachusetts 02111.
Clin Cardiol. 1988 Sep;11(9):639-41. doi: 10.1002/clc.4960110909.
Paradoxical hypertension is a relatively common complication of surgical repair of coarctation of the aorta. An early phase of systolic hypertension has been ascribed to elevated levels of norepinephrine. Activation of the renin-angiotensin system from sympathetic stimulation has been implicated in a later phase of systolic and diastolic hypertension that can result in mesenteric arteritis. The use of a rapidly acting, titratable intravenous alpha- and beta-adrenergic blocker, such as labetalol hydrochloride, addresses both of these neurohormonal mechanisms. In the intravenous form, it would appear to be an excellent choice for the management of early postoperative hypertension and it can be converted to the oral form in cases of persistent hypertension. We report for the first time the use of labetalol in two young patients for the control of paradoxical hypertension following coarctation repair.
矛盾性高血压是主动脉缩窄手术修复相对常见的并发症。收缩期高血压的早期阶段归因于去甲肾上腺素水平升高。交感神经刺激激活肾素 - 血管紧张素系统与收缩期和舒张期高血压的后期阶段有关，这可能导致肠系膜动脉炎。使用快速起效、可滴定的静脉内α和β肾上腺素能阻滞剂，如盐酸拉贝洛尔，可解决这两种神经激素机制。以静脉注射形式给药，它似乎是术后早期高血压管理的极佳选择，对于持续性高血压病例可转换为口服形式。我们首次报告在两名年轻患者中使用拉贝洛尔控制主动脉缩窄修复术后的矛盾性高血压。
