Olmos M, Guijarrubia E G, Maestro B, Ballester J A, Vidarte M A
Servicio de Anestesiología y Reanimación, Hospital de Basurto, Bilbao.
Rev Esp Anestesiol Reanim. 1998 Oct;45(8):326-32.
To determine the efficacy of high doses of propofol for controlling hypertension during coronary surgery and to compared cardiovascular stability with propofol to that observed under lower doses of propofol with nitroprusside.
Forty patients were studied prospectively. The patients had good ventricular function and were scheduled for coronary surgery, randomized to two groups. Group P (n = 20) received 0.3 mg/kg propofol plus a 10 mg/kg/h perfusion. Hypertensive responses were treated with boluses of 0.3 mg/kg of propofol and progressive increases in the perfusion dose of 2.5 mg/kg/h at intervals of 2 minutes (maximum 15 mg/kg/h). If hypertension persisted it was treated with nitroprusside. Group N (n = 20) received propofol in perfusion at a dose of 8 mg/kg/h and hypertension was controlled directly with nitroprusside. During extracorporeal circulation, the propofol dose was reduced to 3 mg/kg/h in both groups and was adjusted in response to changes in arterial pressure, with nitroprusside added as needed. We recorded the number of patients becoming hypertensive during sternotomy and mediastinal dissection, the maximum doses of propofol and nitroprusside and the time taken to achieve control of hypertension. Arterial pressure and heart rate were recorded at intervals of one minute throughout the operation.
Eight patients in group P and eleven in group N suffered hypertension (NS). Increasing the dose of propofol in group P controlled arterial hypertension in one patient. We found no significant differences between groups in amount of nitroprusside needed or time taken to bring episodes under control. Differences between the two groups in rates of intraoperative hypertension (65% in group P and 85% in group N) and hypotension (75% in group P and 55% in group N) and in duration of episodes were not statistically significant.
Using high doses of propofol rather than moderate doses in combination with nitroprusside in coronary surgery does not improve control of either hypertension or hemodynamic stability.
确定高剂量丙泊酚在冠状动脉手术中控制高血压的疗效，并将丙泊酚组的心血管稳定性与低剂量丙泊酚联合硝普钠组进行比较。
前瞻性研究40例患者。这些患者心室功能良好，计划进行冠状动脉手术，随机分为两组。P组（n = 20）给予0.3mg/kg丙泊酚加10mg/kg/h持续输注。高血压反应通过静脉推注0.3mg/kg丙泊酚及每2分钟将持续输注剂量逐步增加2.5mg/kg/h（最大15mg/kg/h）进行处理。若高血压持续存在，则用硝普钠治疗。N组（n = 20）以8mg/kg/h的剂量持续输注丙泊酚，高血压直接用硝普钠控制。体外循环期间，两组丙泊酚剂量均减至3mg/kg/h，并根据动脉压变化进行调整，必要时加用硝普钠。记录胸骨切开术和纵隔解剖期间出现高血压的患者数量、丙泊酚和硝普钠的最大剂量以及控制高血压所需时间。整个手术过程中每隔1分钟记录动脉压和心率。
P组8例患者、N组11例患者出现高血压（无统计学差异）。P组增加丙泊酚剂量仅控制了1例患者的动脉高血压。两组在所需硝普钠量或控制发作所需时间方面无显著差异。两组在术中高血压发生率（P组65%，N组85%）、低血压发生率（P组75%，N组55%）及发作持续时间方面的差异无统计学意义。
在冠状动脉手术中，使用高剂量丙泊酚而非中等剂量丙泊酚联合硝普钠并不能改善高血压控制或血流动力学稳定性。
