Smulyan H, Weinberg S E, Howanitz P J
JAMA. 1982 May 14;247(18):2539-42.
Thirteen patients given long-term propranolol hydrochloride therapy for heart disease required 15 abdominal surgical procedures. On each occasion, propranolol therapy was maintained postoperatively by continuous intravenous infusion. Duration of infusion ranged from one to nine days, and each infusion was monitored with frequent measurements of serum propranolol concentrations. In patients with normal hepatic and renal function, therapeutic serum propranolol levels were attained with a narrow dose range averaging 3.0 mg/hr, irrespective of body weight. All patients had postoperative courses free of complications attributable to beta-blockade. This form of therapy appears to protect against sympathetic stimulation during the perioperative period and to prevent the propranolol withdrawal syndrome in such patients. Continuous propranolol infusion might also be useful in other clinical situations, such as acute aortic dissection or severe thyrotoxicosis, where predictable therapeutic serum propranolol levels could be maintained when oral therapy was contraindicated.
13例因心脏病接受长期盐酸普萘洛尔治疗的患者需要进行15次腹部外科手术。每次手术后，均通过持续静脉输注维持普萘洛尔治疗。输注持续时间为1至9天，每次输注期间均通过频繁测定血清普萘洛尔浓度进行监测。在肝肾功能正常的患者中，无论体重如何，平均以3.0毫克/小时的窄剂量范围即可达到治疗性血清普萘洛尔水平。所有患者术后病程均无因β受体阻滞引起的并发症。这种治疗方式似乎可防止围手术期交感神经刺激，并预防此类患者出现普萘洛尔撤药综合征。持续输注普萘洛尔在其他临床情况中可能也有用，如急性主动脉夹层或严重甲状腺毒症，在这些情况下，当口服治疗禁忌时，可维持可预测的治疗性血清普萘洛尔水平。
