普鲁卡因氯胺酮静脉复合麻醉对失血性休克犬体循环和冠脉循环 …

目的与方法：观察失血性休克犬在普鲁卡因，氯胺酮复合静脉麻醉下６０ｍｉｎ内体循环和冠脉循环血流动力学及心肌代谢的变化。结果：除外周血管总阻力下降外，其他体循环及冠脉循环血流动力学指标均无明显的改变。动脉血和冠状窦血乳酸含量增加，心肌酸摄取速率和摄取率明显上升。结论：在失血性休克状态下应用普鲁卡因，氯胺酮复合静脉麻醉后心血管功能基本稳定在麻醉前水平，心脏后负荷有所降低，心肌氧供略增，氧耗稍减，保持心肌     

神经安定镇痛普鲁卡因静脉复合麻醉对失血性休克犬体循环和冠脉循环血流动力学及心肌代谢的影响

实验研究神经安定镇痛、普鲁卡因静脉复合麻醉对失血性休克犬体循环和冠脉循环血流动力学及心肌代谢的影响。结果表明，神经安定镇痛、普鲁卡因静脉复合麻醉抑制失血性休克状态下的心血管功能，降低心肌血流量，使得心肌氧供需失衡，心肌缺血缺氧。     

神经安定镇痛普鲁卡因静脉复合麻醉对失血性休克犬体循环和冠…

实验研究神经安定镇痛、普鲁卡因静脉复合麻醉对失血性休克犬体循环和冠脉循环血流动力学及心肌代谢的影响。结果表明，神经安定镇痛、普鲁卡因静脉复合麻醉抑制失血性休克状态下的心血管功能，降低心肌血流量，使得心肌氧供需失衡，心肌缺血缺氧。     

静脉普鲁卡因对失血性休克犬血流动力学影响

静脉普鲁卡因复合麻醉在正常血容量下对血流动力学的影响已有报道。但在失血性休克情况下,应用静脉普鲁卡因复合全麻是否适合尚无统一看法。本实验是探讨在失血性休克情况下,静脉普鲁卡因对血流动力学的影响,以便为临床麻醉提供参考。材料和方法 (一)杂种犬7只,雌雄兼有,体重13～20kg。先以戊巴比妥钠25～30mg/kg静脉麻醉,气管     

普鲁卡因静脉复合麻醉对肝脏血流和氧耗影响的实验研究

采用电磁血流仪和血气分析等技术，研究普鲁卡因静脉复合麻醉对犬体循环血流动力学及肝脏血流和氧耗影响。 １％普鲁卡因复合液以 １．０ｍｇ· ｋｇ－１／ｍｉｎ速度静滴时，随麻醉时间延长，血浆普鲁卡因浓度逐渐升高，６０分钟达５６．９±８．７ｍｇ／Ｌ。体循环各项血流动力学参数趋于稳定，仅在６０分钟产生明显的体循环抑制效应。心率和平均动脉压分别降低２７％、２５％，心指数由３．５２±０．２１Ｌ·ｍｉｎ－１／ｍ２降至 ３． ０８±０．１２Ｌ· ｍｉｎ－１／ｍ２。肝总血流量和氧耗与体循环动力学呈一致性变化。因此，肝脏疾患及肝手术的患者，只要控制血中普鲁卡因浓度不过高，仍可安全实施普鲁卡因静脉复合麻醉。     

复方丹参液对失血性休克家兔血流及氧动力学的影响

目的：探讨复方丹参注射液改善失血性休克家兔氧动力学、血流动力学的可行性。方法：20只家兔随机分为丹参组和休克组。观察两组家兔休克前、休克即刻、休克1h、3h、6h、12h心指数（CI）、全身血管阻力指数（SVRI）、肺血管阻力指数（PVRI）混合静脉血氧饱和度（SvO2）、氧输送（DO2）、氧消耗（VO2）、氧摄取率（ERO2）、动脉血乳酸（LA）变化及DO2与VO2的关系。结果：休克组于休克1h时SVRI、PVRI、CI、DO2、SvO2较休克前无明显变化（P〉0.05）,于休克3h与休克前比较CI、DO2、SvO2显著降低,ERO2显著增加,（P〈0.05）,VO2保持不变,DO2与VO2呈非依赖关系。休克6h,当DO2降至397mL（min.m2）时,VO2明显降低,DO2与VO2线性相关,相关系数γ=0.62。丹参组于休克1h和3h时SVRI、PVRI、CI、DO2、SvO2与休克前比较无明显变化（P〉0.05）,于休克6h后,SVRI、PVRI、CI、DO2、SvO2降低,但与休克前比较无明显差异。丹参组休克后,CI、ERO2与休克前无显著改变。DO2、VO2显著升高。丹参组DO2与VO2亦呈线性相关（相关系数r=0.34,P〈0.05。丹参组DO2、VO2关系曲线斜率明显低于休克组,相关系数明显降低。两组血乳酸水平于休克后1h无明显变化,于休克3h均明显升高（P〈0.05）,于休克后6h休克组血乳酸水平持续升高,丹参组较前下降,但高于休克前,于休克12h休克组达（8.70±0.73）mmol/L,丹参组下降至休克前水平。结论：失血性休克家兔出现血流动力学、氧动力学障碍,复方丹参注射液可改善这种状况。     

纳络酮对失血性休克的临床效果

作者观察了２１例中度失血性休克患者应用纳络酮后的血流动力学、血儿茶酚胺及血乳酸变化。结果表明静脉注射纳络酮０．０２ｍｇ／ｋｇ能明显提高患者血儿茶酚胺浓度、平均动脉压，并增加外周血管阻力，单纯输注生理盐水２００ｍｌ后患者动、静脉血乳酸轻度下降动－静脉血乳酸差值仍为负值；注射纳络酮后动、静脉血乳酸显著下降，其差值为正值。这说明注射纳络酮后，机体组织缺氧改善，乳酸摄取转化能力提高。     

普鲁卡因静脉麻醉对内皮素及降钙素基因相关肽的影响及其临床意义

目的：探讨普鲁卡因静脉麻醉期间ＥＴ和ＣＧＲＰ的变化及其临床意义。方法：观察１９例腹部择期手术病人在普鲁卡因静脉麻醉下ＥＴ、ＣＧＲＰ及血流动力学的变化。结果：血浆ＥＴ水平在术中明显升高,血浆ＣＧＲＰ水平在术中明显降低,麻醉期间ＣＯ明显降低,而ＳＶＲ则明显升高;相关分析表明,血浆ＥＴ水平与ＣＯ、ＣＧＲＰ水平与ＳＶＲ均呈显著负相关关系。结论：在普鲁卡因静脉麻醉所致的循环抑制中,ＥＴ、ＣＧＲＰ的变化可能具     

不同液体输液对犬失血性休克时的血流动力学,氧转运及血管外…

以犬为实验对象研究不同液体输注对失血性休克时的血流动力学，氧转运及血管外肺水的影响。方法：选择成年健康犬１５只，静脉麻醉后通过动脉放血至平均动脉压４．６７ｋＰａ制作失血性休克模型，继分别以乳酸钠林格氏液，全血及多聚明胶等三种液体输注复苏，以ＰＡＷＰ值恢复至２．０ｋＰａ为输全液终点，观察血流动力学，氧转运和血管外肺水等各指标的变化。     

不同液体输注对犬失血性休克时的血流动力学、氧转运及血管外肺水的影响

目的:以犬为实验对象研究不同液体输注对失血性休克时的血流动力学、氧转运及血管外肺水的影响。方法:选择成年健康犬15只,静脉麻醉后通过动脉放血至平均动脉压4.67kPa制作失血性休克模型,继分别以乳酸钠林格氏液、全血及多聚明胶等三种液体输注复苏,以PAWP值恢复至2.0kPa为输血输液终点,观察血流动力学、氧转运和血管外肺水等各指标的变化。结果:乳酸钠林格氏液组的血流动力学各项指标虽然于复苏即刻恢复至对照水平,但复苏后30分钟CI、SVI即降至低于对照水平,而全血组和多聚明胶组于复苏即刻及复苏后30分钟均可明显恢复血流动力学各指标,并且多聚明胶组在CI、SVI、SVRI等各指标较其它两组为好。结论:在失血性休克输液治疗过程中,胶体液较晶体液更为有效,且对血管外肺水影响较小。多聚明胶能更有效地改善血流动力学状态,全血能明显增加氧转运。     

Changes in myocardial blood flow and systemic hemodynamics during hypotensive anesthesia induced by adenosine triphosphate with or without dipyridamole]

The changes in myocardial blood flow and systemic hemodynamics during hypotensive anesthesia with adenosine triphosphate (ATP) or ATP with dipyridamole (0.5 mg.kg-1) were studied in 20 mongrel dogs anesthetized with 0.7% halothane in 100% oxygen. In both groups, mean arterial blood pressure (MAP) was reduced to 60 mmHg by intravenous administration of ATP. During hypotensive anesthesia, coronary blood flow, myocardial blood flow and cardiac index increased significantly in both groups. Lactic acid and uric acid increased significantly during hypotensive anesthesia in the group 1. Heart rate, MAP, systemic vascular resistance and coronary vascular resistance decreased significantly during hypotensive anesthesia in both groups. Mean pulmonary arterial pressure, pulmonary arterial wedge pressure and central venous pressure showed no significant changes in both groups. Base excess in the group 1 increased markedly compared with the group 2. We conclude that pretreatment with dipyridamole can prevent metabolic acidosis that occurs during hypotensive anesthesia induced by ATP.     

High thoracic epidural anesthesia for off-pump coronary artery bypass surgery

OBJECTIVE: To assess the feasibility of high thoracic epidural anesthesia combined with sevoflurane for off-pump coronary artery bypass surgery and to evaluate the postoperative pain control, side effects, and perioperative hemodynamics. DESIGN: Retrospective review of prospectively collected data. SETTING: A university teaching hospital. PARTICIPANTS: One hundred six consecutive patients receiving thoracic epidural combined with sevoflurane. INTERVENTION: From November 1999, the patients undergoing off-pump coronary artery bypass grafting were offered the epidural-inhalation anesthetic approach. MEASUREMENTS AND MAIN RESULTS: Insertion of the epidural catheter was successful in all but 2 patients; 1 bloody tap occurred and the dura was never punctured, although 1 patient presented with postoperative paraplegia. An emergency spinal cord nuclear magnetic resonance excluded signs of medullary compression caused by epidural or spinal hematoma. Visual analog scale scores for pain during the first 24-hour period were < 2 in all patients. Mean time to extubation was 4.6 +/- 2.9 hours. The average intensive care unit stay was 1.5 +/- 0.8 days. Incidences of perioperative myocardial infarction, myocardial ischemia, and atrial fibrillation were 2.8%, 7.5%, and 10.6%, respectively. Two patients died: 1 from multiorgan failure and the other from myocardial infarction. Heart rate, mean arterial pressure, cardiac index, and systemic vascular resistance were not affected by thoracic epidural alone. Mean arterial pressure and cardiac index decreased (p < 0.05) when general anesthesia was induced and remained stable thereafter. Neither heart rate nor systemic vascular resistance changed from baseline during operation. CONCLUSIONS: Thoracic epidural as an adjunct to general anesthesia is a feasible technique in off-pump coronary artery bypass surgery. It induces intense postoperative analgesia and does not compromise central hemodynamics.     

The interaction of MCI-154, a calcium sensitizer, and isoflurane on systemic and coronary hemodynamics in chronically instrumented dogs

We conducted this study to determine the interaction of MCI-154, 6-[4-(4'-pyridylamino)phenyl]-4,5-dihydro-3(2H)-pyridazinone hydrochloride, a calcium sensitizer, and isoflurane on myocardial contractility as well as systemic and coronary hemodynamics in chronically instrumented dogs after pharmacological autonomic nervous system activity blockade. MCI-154 increased heart rate and left ventricular function with no change in rate pressure product, pressure work index, and coronary blood flow, with a decrease in coronary vascular resistance (CVR) in the conscious state. Isoflurane decreased heart rate and left ventricular function, with a decrease in rate pressure product and pressure work index. Isoflurane also decreased CVR, but not coronary blood flow. The cardiovascular actions of MCI-154 during isoflurane anesthesia were qualitatively similar to those observed in the conscious state. In contrast to the finding in the conscious state, MCI-154 reversed the decrease in cardiac output and preload recruitable stroke work caused by isoflurane, but these are not significantly different from the effects of isoflurane alone. These results indicate that MCI-154 increases myocardial contractility and decreases CVR without changing calculated myocardial oxygen consumption during both the conscious state and isoflurane anesthesia. IMPLICATIONS: MCI-154, a calcium sensitizer, restores the myocardial contractility depressed by isoflurane and enhances the coronary vasodilating effect of isoflurane in chronically instrumented dogs.     

局部心肌顿抑对全身血液动力学及心肌氧供需平衡的影响

目的 观察局部心肌顿抑对全身血液动力学及心肌氧供需平衡的影响。方法 杂种犬３３条,常温下冠状动脉左前降支根部阻断１５ｍｉｎ,观察再灌注后全身血液动力学、冠脉流量及缺血心肌氧供氧耗的变化。结果 ＭＡＰ在冠脉阻断期间稍下降,再灌注后升至基础水平;ＨＲ在缺血／再灌注过程中均明显增快;冠脉阻断后,ＣＯ、ＳＶ、左室收缩功指数均迅疾下降,再灌注５ｍｉｎ略有升高,之后进行性下降;再灌注后,体循环血管阻力、肺血管     

Low-dose enflurane as adjunct to high-dose fentanyl in patients undergoing coronary artery surgery: stable hemodynamics and maintained myocardial oxygen balance

The effects of enflurane (end-tidal concentration 0.7%) on central and coronary hemodynamics and myocardial oxygenation were studied during steady state, high-dose fentanyl anesthesia in ten patients undergoing coronary artery bypass grafting operations. Compared with the response in ten patients receiving the same fentanyl anesthesia (100 micrograms/kg) without enflurane supplementation, enflurane caused a moderate reduction in mean arterial pressure, systemic vascular resistance, and left ventricular stroke work index. No patient showed signs of myocardial ischemia, and mean coronary sinus flow and calculated coronary resistance remained unchanged. Surgical stimulation induced no central or coronary hemodynamic responses in the enflurane-fentanyl group. No coronary hemodynamic changes occurred in the fentanyl group, but a marked increase in arterial pressure and systemic vascular resistance was seen. Myocardial oxygen extraction decreased in the enflurane supplemented group although it increased in the fentanyl group after surgical stimulation. Three fentanyl group patients and one enflurane-fentanyl group patient had a low myocardial lactate extraction as a sign of myocardial ischemia during surgery. We conclude that a 0.7% enflurane supplementation of 100 micrograms/kg fentanyl anesthesia does not endanger myocardial oxygenation and effectively prevents central and coronary hemodynamic responses to skin incision and sternotomy in patients undergoing coronary artery surgery.     

Control of intraoperative hypertension with isoflurane in patients with coronary artery disease: effects on regional myocardial blood flow and metabolism

The effect of isoflurane on regional myocardial metabolism and blood flow, when used as an adjunct to fentanyl-nitrous oxide anesthesia, to control intraoperative hypertension was investigated. Twenty-two patients with two- or three-vessel coronary artery disease with an ejection fraction greater than 0.5 and on beta-blockers up to the morning of surgery were studied during elective coronary artery by-pass grafting. Systemic and pulmonary hemodynamics, and regional (great cardiac vein, GCVF) myocardial blood flow and myocardial metabolic parameters were measured. In 10 patients, both GCVF and global (coronary sinus, CSF) myocardial blood flows were recorded. Measurements were made 1) after induction of anesthesia but prior to skin incision, 2) during sternotomy, and 3) during isoflurane administration after its use to reduce arterial pressure to the presternotomy level. The increase in systemic arterial pressure during sternotomy was due to an increase in systemic vascular resistance accompanied by increases in heart rate, pulmonary capillary wedge pressure, (PCWP) regional myocardial oxygen consumption and extraction, GCVF and total coronary vascular resistance. Isoflurane reduced systemic arterial pressure but not PCWP, to presternotomy levels within 6.9 +/- 0.7 minutes at an end-tidal concentration of 1.5 +/- 0.2%. Isoflurane induced a pronounced systemic and coronary vasodilatation and increases in cardiac index, heart rate and regional myocardial oxygen extraction while the GCVF/CSF ratio remained unchanged. While mean regional--MLE% values were not effected by sternotomy, in two patients myocardial lactate production was seen during sternotomy but not during isoflurane. In another two patients, isoflurane induced lactate production.(ABSTRACT TRUNCATED AT 250 WORDS)     

Comparison of two different anesthesia regimens in patients undergoing aortocoronary bypass grafting surgery: sufentanil-midazolam versus remifentanil-propofol

OBJECTIVE: To compare intraoperative hemodynamics and depth of anesthesia using sufentanil-midazolam (SM) versus remifentanil-propofol (RP) anesthesia. DESIGN: Prospective, randomized study. SETTING: Clinical investigation in an urban, university-affiliated hospital. PARTICIPANTS: Forty patients undergoing elective first-time coronary artery bypass graft surgery. Interventions: Twenty patients were anesthetized using SM and 20 patients using RP. MEASUREMENTS AND MAIN RESULTS: Hemodynamic monitoring included a 5-lead electrocardiogram, a radial artery catheter, and a pulmonary artery catheter. Depth of anesthesia was assessed using bispectral index (BIS). Data were obtained after induction of anesthesia (T1), after sternotomy (T2), after pericardiotomy (T3), 5 minutes after cardiopulmonary bypass (CPB) (T4), after closure of thorax (T5), and at the end of surgery (T6). The 2 groups were comparable with regard to demographic and perioperative data. There were no significant differences of any hemodynamic parameter at any time between the 2 groups. In both groups, systemic vascular resistance increased at T2 and decreased at T4 from baseline value (p < 0.05). Cardiac index increased at T4 in both groups from baseline value (p < 0.05); 55% of the patients of both groups needed low-dose dobutamine after CPB. During CPB, 40% of the RP patients needed norepinephrine versus 35% of the SM patients. BIS was lower in the RP than in the SM group at T2 and T3 (p < 0.05). BIS values indicating intraoperative awareness were not noted. CONCLUSION: Both anesthesia regimens provided stable hemodynamics and adequate anesthesia in patients undergoing coronary artery bypass graft surgery.     

Effects of hypocapnia on hemodynamics and myocardial metabolism in anesthetized dogs

The authors previously reported that hypocapnia increased myocardial oxygen demand under droperidol-fentanyl (D-F) anesthesia. In this study, we observed myocardial oxygen tension, hemodynamics, and coronary arterial-venous blood content differences of oxygen and lactate before and after hyperventilation in dogs with and without a narrowed coronary artery under halothane anesthesia. We studied the functional and metabolic responses of the heart to hypocapnia under halothane in comparison with D-F anesthesia. In the intact heart, heart rate, LV dp/dt max and myocardial energy demand (heart rate x systolic aortic pressure x LV dp/dt max), which increased during hypocapnia under D-F anesthesia, were unchanged during hypocapnia under halothane anesthesia. Aortic pressure and coronary flow were unchanged under both types of anesthesia. Though subendocardial oxygen tension decreased significantly, myocardial lactate extraction was unchanged under both types of anesthesia. In the heart with a constricted coronary artery, subendocardial oxygen tension and lactate extraction ratio decreased significantly during hypocapnia under both types of anesthesia. Myocardial lactate production was observed in six of eleven dogs in which myocardial energy demand increased under D-F anesthesia. Myocardial lactate production was observed in one dog under halothane anesthesia. Coronary arterial-venous blood oxygen content difference increased under D-F anesthesia, but not under halothane anesthesia. In summary, hypocapnia increased myocardial oxygen demand under D-F anesthesia but not under halothane anesthesia. In the intact heart under both types of anesthesia, hypocapnia deteriorated myocardial oxygen supply-demand relations, but the evidence of myocardial anaerobic metabolism was not observed.(ABSTRACT TRUNCATED AT 250 WORDS)     

Effects of Respiratory Alkalosis and Acidosis on Myocardial Blood Flow and Metabolism in Patients with Coronary Artery Disease

Background: Variation of the arterial carbon dioxide partial pressure (PaCO2) is not uncommon in anesthetic practice. However, little is known about the myocardial consequences of respiratory alkalosis and acidosis, particularly in patients with coronary artery disease. The aim of the current study was to investigate the effects of variation in PaCO (2) on myocardial blood flow (MBF), metabolism, and systemic hemodynamics in patients before elective coronary artery bypass graft surgery.

Methods: In 10 male anesthetized patients, measurements of MBF, myocardial contractility, metabolism, and systemic hemodynamics were made in a randomized sequence at PaCO2 levels of 30, 40, and 50 mmHg, respectively. The MBF was measured using the Kety-Schmidt technique with argon as a tracer. End-diastolic left ventricular pressure and the maximal increase of left ventricular pressure were assessed using a manometer-tipped catheter.

Results: The cardiac index significantly changed with varying PaCO (2) levels (hypocapnia, - 9%; hypercapnia, 13%). This reaction was associated with inverse changes in systemic vascular resistance index levels. The MBF significantly increased by 15% during hypercapnia, whereas no change was found during hypocapnia. Myocardial oxygen and glucose uptake and the maximal increase of left ventricular pressure were not affected by varying Pa (CO)2 levels.