Silverman N A, Wright R, Levitsky S
Ann Surg. 1982 Aug;196(2):194-7. doi: 10.1097/00000658-198208000-00012.
A prospective, randomized study was performed in 100 consecutive patients undergoing coronary artery bypass surgery to assess the efficacy of the early reinstitution of propranolol in reducing the incidence of postoperative supraventricular tachyarrhythmias (SVT). Patients were randomized to receive propranolol 10 mg every 6 hours enterally starting the morning after surgery (Group I, 50 patients) or to serve as controls (Group II, 50 patients). No patient was excluded because of poor ventricular function, need for urgent revascularization, or transient necessity for ionotropic support. Both groups had a comparable incidence of risk factors, previous infarction, unstable angina, and abnormal ventricular function. The extent of coronary disease, preoperative propranolol dose, and number of grafts performed were also similar. SVT occurred in 3/50 (6%) patients in Group I compared with 14/50 (28%) in Group II (p less than 0.01). There were no preoperative or intraoperative discriminators to predict the occurrence of SVT. In addition, perioperative infarction and the need for mechanical or pharmacologic circulatory support did not predispose to SVT. The data indicate that early administration of propranolol should be given to all patients after myocardial revascularization to decrease the incidence of these postoperative rhythm disturbances.
对100例连续接受冠状动脉搭桥手术的患者进行了一项前瞻性随机研究，以评估早期重新使用普萘洛尔在降低术后室上性心律失常（SVT）发生率方面的疗效。患者被随机分为两组，一组（I组，50例患者）在术后次日早晨开始每6小时口服10 mg普萘洛尔，另一组（II组，50例患者）作为对照组。没有患者因心室功能差、需要紧急血运重建或暂时需要使用正性肌力药物支持而被排除。两组的危险因素、既往梗死、不稳定型心绞痛和心室功能异常的发生率相当。冠状动脉疾病的程度、术前普萘洛尔剂量和所进行的移植血管数量也相似。I组3/50（6%）的患者发生了SVT，而II组为14/50（28%）（p<0.01）。术前或术中没有鉴别因素可预测SVT的发生。此外，围手术期梗死以及对机械或药物循环支持的需求并不会诱发SVT。数据表明，心肌血运重建后应给予所有患者早期普萘洛尔治疗，以降低这些术后节律紊乱的发生率。
