Reiz S, Häggmark S, Rydvall A, Ostman M
Department of Anaesthesia and Critical Care Medicine, University of Umeå, Sweden.
Acta Anaesthesiol Scand Suppl. 1982;76:54-61. doi: 10.1111/j.1399-6576.1982.tb01889.x.
Seven groups of patients with and without hypertension or with ischaemic heart disease, treated with different beta blockers were investigated to study the circulatory effects of neurolept anaesthesia alone or combined with thoracic epidural analgesia from T4 to T12/L2 during abdominal surgery. The combination of thoracic epidural analgesia and neurolept anaesthesia in hypertensive subjects treated with non-cardioselective beta blockers induced slightly lower blood pressure than measured in similar patients on cardioselective beta blockers with neurolept anaesthesia only. Patients on non-selective beta blockers with intrinsic stimulatory activity (ISA) had higher blood pressure and heart rate after neurolept anaesthesia induction than patients on cardioselective blockers. During surgery, heart rate remained at a higher level in the patients treated with ISA blockers, whereas blood pressure increased to the same level as in patients with cardioselective blockers. Cardiovascular stability was, however, best maintained in the epidural group, where myocardial energy expenditure during maximal surgical stress was comparable to that in a group of healthy subjects with the same format of anaesthesia and significantly lower than in healthy subjects with neurolept anaesthesia alone. No circulatory side effects of the combination of thoracic epidural analgesia and beta blockade were seen. In patients with ischaemic heart disease, with or without non-selective beta blockade, similar haemodynamic changes were recorded following neurolept anaesthesia. During maximal surgical stress, unmasking of alpha adrenergic activity with marked rise in blood pressure was seen in the beta-blocked patients. Despite the more accelerated haemodynamic changes in the blocked patients, a lower increase in myocardial oxygen consumption was recorded compared with the non-blocked patients.(ABSTRACT TRUNCATED AT 250 WORDS)
研究了七组患有或未患有高血压或缺血性心脏病的患者，这些患者接受了不同的β受体阻滞剂治疗，目的是研究在腹部手术期间单纯神经安定麻醉或联合T4至T12/L2胸段硬膜外镇痛的循环效应。在接受非心脏选择性β受体阻滞剂治疗的高血压患者中，胸段硬膜外镇痛与神经安定麻醉联合使用时，血压略低于仅接受心脏选择性β受体阻滞剂和神经安定麻醉的类似患者。具有内在刺激活性（ISA）的非选择性β受体阻滞剂患者在神经安定麻醉诱导后的血压和心率高于心脏选择性β受体阻滞剂患者。手术期间，接受ISA阻滞剂治疗的患者心率保持在较高水平，而血压升高至与心脏选择性阻滞剂患者相同的水平。然而，硬膜外组的心血管稳定性最佳，在最大手术应激期间心肌能量消耗与采用相同麻醉方式的一组健康受试者相当，且显著低于仅接受神经安定麻醉的健康受试者。未观察到胸段硬膜外镇痛与β受体阻滞剂联合使用的循环副作用。在患有缺血性心脏病的患者中，无论是否使用非选择性β受体阻滞剂，神经安定麻醉后记录到类似的血流动力学变化。在最大手术应激期间，β受体阻滞剂治疗的患者出现α肾上腺素能活性暴露，血压显著升高。尽管β受体阻滞剂治疗的患者血流动力学变化更为加速，但与未接受阻滞剂治疗的患者相比，心肌氧耗的增加较低。（摘要截短至250字）
