Rosenberg J, Overgaard H, Anderson M M, Rasmussen V, Schulze S
H:S Sundby Hospital, organkirurgisk afdeling.
Ugeskr Laeger. 1997 Sep 8;159(37):5514-8.
The aim of our study was to evaluate the effect of metoprolol on the occurrence of myocardial ischaemia during endoscopic cholangiopancreatography. Thirty-eight (2 x 19) patients scheduled for endoscopic cholangiopancreatography received either metoprolol 100 mg or placebo two hours before endoscopy. During endoscopy, arterial oxygen saturation was measured by continuous pulse oximetry, and the electrocardiogram was monitored continuously with a Holter tape recorder. Myocardial ischaemia was defined as an ST segment deviation > 1 mV from baseline. Heart rate during endoscopy was significantly lower in the metoprolol group compared with the placebo group (p = 0.0002). Twenty-one patients (16 placebo versus five metoprolol, p = 0.0008) developed tachycardia (heart rate > 100/min) during the procedure. A total of eleven patients (ten placebo versus one metoprolol, p = 0.003) developed myocardial ischaemia during the procedure, and myocardial ischaemia was always related to increases in heart rate. In conclusion, metoprolol prevented myocardial ischaemia during endoscopic cholangiopancreatography, probably through a heart rate lowering effect. Thus, tachycardia seems to be a key pathogenic factor in the development of myocardial ischaemia during endoscopy.
我们研究的目的是评估美托洛尔在内镜下胰胆管造影术期间对心肌缺血发生情况的影响。38名（2×19）计划接受内镜下胰胆管造影术的患者在内镜检查前两小时分别服用100毫克美托洛尔或安慰剂。在内镜检查期间，通过连续脉搏血氧饱和度测定法测量动脉血氧饱和度，并用动态心电图记录仪连续监测心电图。心肌缺血定义为ST段相对于基线偏移>1毫伏。与安慰剂组相比，美托洛尔组在内镜检查期间的心率显著降低（p = 0.0002）。21名患者（16名安慰剂组患者与5名美托洛尔组患者，p = 0.0008）在手术过程中出现心动过速（心率>100次/分钟）。共有11名患者（10名安慰剂组患者与1名美托洛尔组患者，p = 0.003）在手术过程中出现心肌缺血，且心肌缺血总是与心率增加有关。总之，美托洛尔在内镜下胰胆管造影术期间预防了心肌缺血，可能是通过降低心率的作用。因此，心动过速似乎是内镜检查期间心肌缺血发生的关键致病因素。
