Margulies D R, Hestrin M A, Lemus J F, Bjerke H S, Treiman R L, Shabot M M
Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA 90048.
Am Surg. 1993 Sep;59(9):578-81.
This study was performed to determine whether bradycardia complicates the postoperative course of patients undergoing carotid endarterectomy (CEA). The records of 216 patients undergoing 233 CEAs over a 2-year period were reviewed. Patients were divided into two groups based on their lowest Surgical Intensive Care Unit (SICU) heart rate (HR). Those with HR < 60 were in the Bradycardic (BRADY) group and those with HR > or = 60 were in the Non-Bradycardic (NON-BRADY) group. One hundred and sixteen patients developed bradycardia, with a mean (+/- SEM) HR of 51.1 +/- 0.5, compared with 117 NON-BRADY patients with a mean HR of 70.6 +/- 0.9 (P < 0.0005). There were no significant differences between the groups in age, use of cardioactive drugs, SICU severity of illness, or length of SICU stay. The systolic blood pressure for BRADY patients averaged 144 +/- 2.2 on admission and 144 +/- 2.2 (P = NS) in the SICU, while that of NON-BRADY patients rose from 143 +/- 2.3 on admission to 156 +/- 2.5 (P = 0.001). Fifty-four patients receiving a second CEA had a SICU HR not significantly different from those patients undergoing a first CEA. Of 17 patients who underwent bilateral CEAs during the study period, SICU HRs averaged 65.1 +/- 3.7 after the first procedure and 64.7 +/- 3.6 after the second (P = NS). The authors conclude that bradycardia following CEA is a frequent but benign postoperative finding that does not affect outcome, cause significant hypotension, or prolong the SICU stay.
本研究旨在确定心动过缓是否会使接受颈动脉内膜切除术（CEA）患者的术后病程复杂化。回顾了216例患者在两年内接受233次CEA的记录。根据患者在外科重症监护病房（SICU）的最低心率（HR）将患者分为两组。心率<60次/分的患者为心动过缓组（BRADY），心率≥60次/分的患者为非心动过缓组（NON-BRADY）。116例患者发生心动过缓，平均（±标准误）心率为51.1±0.5次/分，而117例非心动过缓患者的平均心率为70.6±0.9次/分（P<0.0005）。两组在年龄、使用心血管活性药物、SICU疾病严重程度或SICU住院时间方面无显著差异。心动过缓组患者入院时收缩压平均为144±2.2，在SICU时为144±2.2（P=无显著性差异），而非心动过缓组患者入院时收缩压为143±2.3，在SICU时升至156±2.5（P=0.001）。54例接受二次CEA的患者在SICU的心率与接受首次CEA的患者无显著差异。在研究期间接受双侧CEA的17例患者中，首次手术后SICU心率平均为65.1±3.7次/分，第二次手术后为64.7±3.6次/分（P=无显著性差异）。作者得出结论，CEA术后心动过缓是一种常见但良性的术后表现，不影响预后，不会导致明显低血压，也不会延长SICU住院时间。
