Gidding S S, Rocchini A P, Beekman R, Szpunar C A, Moorehead C, Behrendt D, Rosenthal A
N Engl J Med. 1985 May 9;312(19):1224-8. doi: 10.1056/NEJM198505093121904.
Patients undergoing repair of coarctation of the aorta often have self-limited but severe hypertension in the first week after surgery (paradoxical hypertension). We conducted a controlled trial of treatment with propranolol before repair of coarctation of the aorta in 14 children to determine whether the drug would prevent paradoxical hypertension. Seven patients were randomly assigned to receive propranolol for two weeks before surgery and throughout the first postoperative week, and seven patients were assigned to receive standard postoperative care. Both groups had a similar significant (P less than 0.05) increase in the plasma norepinephrine level in response to surgery; however, when compared with no treatment, treatment with propranolol reduced not only the rise in systolic (P = 0.004) and diastolic (P = 0.003) blood pressure but also the postoperative increase in plasma renin activity (P less than 0.01). We conclude that prophylactic propranolol can prevent paradoxical hypertension and should therefore become a routine part of the operative care of patients with coarctation of the aorta.
接受主动脉缩窄修复术的患者在术后第一周常出现自限性但严重的高血压（矛盾性高血压）。我们对14名儿童在主动脉缩窄修复术前使用普萘洛尔治疗进行了一项对照试验，以确定该药是否能预防矛盾性高血压。7名患者被随机分配在手术前两周及术后第一周全程接受普萘洛尔治疗，7名患者被分配接受标准的术后护理。两组患者在手术应激下血浆去甲肾上腺素水平均有相似的显著升高（P<0.05）；然而，与未治疗相比，普萘洛尔治疗不仅降低了收缩压（P = 0.004）和舒张压（P = 0.003）的升高，还降低了术后血浆肾素活性的升高（P<0.01）。我们得出结论，预防性使用普萘洛尔可预防矛盾性高血压，因此应成为主动脉缩窄患者手术护理的常规组成部分。
