Caution of Using Antihypertensive Drugs in Early Post-Cardiac Surgical Patients: A Case Report

治療早期心臓手術後病人高血壓之注意事項：一病例報告

柯文哲(Wen-Je Ko) ； 蔡壁如(Pi-Ru Tsai) ； 朱樹勳(Shu-Hsun Chu)

《中華民國急救加護醫學會雜誌》 7卷1期 (1996/03) Pp. 20-26

https://doi.org/10.30018/JECCM.199603.0004

摘要

高血壓常見於開心手衍援早期，且有許多併發症，因此需緊急治療。我們報告一位接受開心手衍（僧帽瓣置換，冠狀動脈繞道手街）的病人，於術後早期出現高血壓。因為 nitroprusside 輸注引起反射性心跳過速，我們改用esmolol輸注，雖然在 esmolol 輸注下，血壓、心跳、心搏出量仍維持正常，後來卻意外出現血行動力變壞。這是因手衍後高代謝、低體溫、貧血等，造成所謂正常的心持出量，事實上，不夠身體所需。而循環的不足夠，即表現在低混合靜脈血氧濃度。Esmolo輸注，進一步減少心搏出量，而造成血行動力的崩潰。在此我們強調血壓、心跳、心搏出量皆不足以判斷開心手衍後高血壓治療是否得當，混合靜脈血氧濃度也應考慮。

關鍵字

混合靜脈血氣濃度 ； esmolol ； nitroprusside ； 高血壓 ； 開心手衍

並列摘要

Hypertension is common in early postoperative period of cardiac surgery and is felt to require urgent treatment. Such treament is associated with a number of complications. We report a case of an open heart surgery (mitral valve replacement and aortocoronary bypass with saphenous vein graft) who developed hypertension in the early postoperative period. Because of reflex tachycardia induced by nitroprusside infusion, treatment was changed to an esmolol infusion. Following the normalization of blood pressure (BP) and heart rate (HR) on esmolol infusion, the patient experienced an unexpected hemodynamic deterioration. Because of the postoperative hypermetabolism, hypothermia, and anemia, the ”normal” cardiac output (C.O.) was felt to be relatively insufficient in this patient prior to the esmolol infusion. Circulatory insufficiency was reflected by low mixed venous oxygen saturation (Sv02). The esmolol infusion further compromised C. 0. and caused hemodynamic deterioration. It is emphasized that BP, HR, C.O. alone are not enough when determining appropriate treatment for hypertension immediately following cardiac surgery, Sv02 should also be included.

並列關鍵字

mixed venous oxygen saturation ； esmolol ； nitroprusside ； hypertension ； cardiac surgery