Objective

Paradoxical hypertension after repair of coarctation of the aorta in children is associated with the release of catecholamines and activation of the renin-angiotensin system. The objective of the present study was to describe the effects of labetalol infusion on blood pressure, plasma catecholamine levels, and plasma renin activity in a series of children undergoing repair of coarctation of the aorta.

Design

Prospective, observational cohort study.

Setting

Tertiary children's hospital with university affiliation.

Participants

The study was comprised of 15 consecutive children older than 1 year undergoing repair of coarctation of the aorta.

Interventions

Intravenous infusion of labetalol, up to 20 µg/kg/min, was administered when patients became hypertensive after release of the aortic cross-clamp. Supplementation with nitroprusside was allowed as needed.

Measurements and Main Results

Blood pressure was maintained below baseline values throughout the labetalol infusion. Plasma norepinephrine increased from 160 ± 81 pg/mL (preoperative) to 657 ± 268 pg/mL (6 h after release of aortic cross-clamp). Plasma renin activity decreased from 16.6 ± 9.7 ng/kg/h (at cross-clamp release) to 2.2 ± 2.2 ng/kg/h (6 h after cross-clamp release). Nitroprusside was added for 12 patients, at a highest mean dose of 2.4 ± 2.5 μg/kg/min.

Conclusions

Labetalol inhibited activation of the renin-angiotensin system and helped control paradoxical hypertension after coarctation repair in children.

中文翻译：

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在儿童缩窄主动脉缩窄后，Labetalol输注可减轻矛盾的高血压并降低血浆肾素活性。

目的

小儿主动脉缩窄修复后的悖论性高血压与儿茶酚胺的释放和肾素-血管紧张素系统的激活有关。本研究的目的是描述在接受修复主动脉缩窄的一系列儿童中，拉贝洛尔输注对血压，血浆儿茶酚胺水平和血浆肾素活性的影响。

设计

前瞻性，观察性队列研究。

设置

附属于大学的三级儿童医院。

参加者

该研究由15名年龄在1岁以上的连续儿童组成，他们接受了主动脉缩窄的修复。

干预措施

当患者在释放主动脉夹钳后出现高血压时，静脉注射拉贝洛尔，最高可达20 µg / kg / min。根据需要允许补充硝普钠。

测量和主要结果

在整个拉贝洛尔输注过程中，血压均保持在基线值以下。血浆去甲肾上腺素从160±81 pg / mL（术前）增至657±268 pg / mL（主动脉夹钳释放后6 h）。血浆肾素活性从16.6±9.7 ng / kg / h（交叉钳释放时）降至2.2±2.2 ng / kg / h（交叉钳释放后6小时）。12例患者加入硝普钠，最高平均剂量为2.4±2.5μg/ kg / min。

结论

拉贝洛尔抑制儿童缩窄修复后肾素-血管紧张素系统的活化，并有助于控制矛盾的高血压。