Peden N R, Browning M C, Feely J, Forrest A L, Gunn A, Hamilton W F, Isles T E
Q J Med. 1985 Sep;56(221):579-91.
We have compared the clinical and metabolic responses of three groups of patients undergoing subtotal thyroidectomy for hyperthyroid Graves' disease. These patients were prepared for surgery with propranolol alone, propranolol plus potassium iodide or the long acting beta-adrenoceptor antagonist nadolol plus potassium iodide. Pre-treatment with potassium iodide reduced serum T4 to normal or subnormal in all patients. Patients in the propranolol group had significantly higher pulse rates and temperatures after operation and one patient developed an exacerbation of the hypermetabolic state. The perioperative rise in serum cortisol and blood glucose was delayed in patients in the propranolol group and this was also noted in one severely hyperthyroid patient on propranolol + potassium iodide. Nadolol was administered once daily as compared to multiple daily doses with propranolol. Despite this, plasma nadolol levels were consistently higher throughout the perioperative period while propranolol levels in patients on both propranolol alone and propranolol + potassium iodide were highly variable and sometimes undetectable. We conclude that, in the rapid preparation of patients with hyperthyroid Graves' disease for surgery, the combination of nadolol + potassium iodide has significant advantages over the other two regimens.
我们比较了三组因甲状腺功能亢进的格雷夫斯病接受甲状腺次全切除术患者的临床和代谢反应。这些患者分别单独使用普萘洛尔、普萘洛尔加碘化钾或长效β-肾上腺素能受体拮抗剂纳多洛尔加碘化钾进行术前准备。所有患者术前使用碘化钾后血清T4均降至正常或低于正常水平。普萘洛尔组患者术后脉搏率和体温显著更高，且有一名患者出现高代谢状态加重。普萘洛尔组患者围手术期血清皮质醇和血糖升高延迟，这在一名使用普萘洛尔加碘化钾的重度甲状腺功能亢进患者中也有观察到。纳多洛尔每日给药一次，而普萘洛尔则每日多次给药。尽管如此，围手术期血浆纳多洛尔水平始终较高，而单独使用普萘洛尔和普萘洛尔加碘化钾的患者中普萘洛尔水平变化很大，有时甚至检测不到。我们得出结论，在快速准备甲状腺功能亢进的格雷夫斯病患者进行手术时，纳多洛尔加碘化钾的联合用药方案比其他两种方案具有显著优势。
