ATP和SNP控制性降压对血流动力学的影响

对比研究三磷酸腺苷（ＡＴＰ）和硝普钠（ＳＮＰ）控制性降压对氯胺酮麻醉犬血流动力学的影响。选择犬１４只，随机分为ＡＴＰ组和ＳＮＰ组，由股静脉持续输入ＡＴＰ和ＳＮＰ使ＭＡＰ降低３０％￣４０％，维持３０ｍｉｎ，分别于降压前、降压后１５ｍｉｎ、３０ｍｉｎ及停止降压后１５ｍｉｎ用Ｓｗａｎ－Ｇａｎｚ漂浮导管测定血流动力学指标。结果表明，ＡＴＰ、ＳＮＰ降压期间ＳＶＲ、ＬＶＳＷ显著降低，ＣＯ、ＰＣＷＰ、ＳＶ、ＲＶ     

尼莫地平和异氟醚控制性降压期间血流动力学变化的对比研究

用经气管超声多普勒心排血量监测仪对３０例脑膜瘤或脑动静脉畸形手术患者，随机分组（各１５例）对比观察了尼莫地平（Ｎ）或异氟醚（Ｉ）控制性降压期间血流动力学的变化。结果表明，Ｉ组异氟醚吸入加深麻醉（２．０３￣２．２８ＭＡＣ），降压期间ＭＡＰ、ＴＰＲ分别下降２１．０％￣２５．９％和２２．９％￣２４．１％，ＳＩ无明显变化，ＨＲ和ＣＩ分别增加８．３％￣９．４％和２．５％￣７．３％，停降压后血压迅速回升；Ｎ组     

前列腺素E1与硝普钠控制性降压对犬血流动力学影响的对比研究

对比研究了普鲁卡因复合麻醉下前列腺素Ｅ１（ＰＧＥ１）与硝普钠（ＳＮＰ）控制性降压时犬血流动力学变化。结果表明，ＳＮＰ降压组有显著的反射性心动过速和反跳性高血压，ＰＧＥ；降压组两者均无。ＰＧＥ１降压时心指数、肺动脉压等其它血流动力学参数亦比ＳＮＰ稳定，提示在保证心肌氧供求平衡及防止血管意外方面ＰＧＥ１降压优于ＳＮＰ。     

尼莫地平对体外循环过程中脑氧耗与脑糖利用的影响

目的：观察体外循环心肺转流（ＣＰＢ）期间脑氧耗与脑糖利用相关性及尼莫地平对其影响。方法：３５例心脏直视手术病人随机分为对照组（ｎ＝１５）和观察组（ｎ＝２０）．监测ＣＰＢ期间不同时期的桡动脉和颈内静脉上球部ＰａＯ２、ＰｊＯ２、ＳａＯ２、ＳｊＯ２及血糖（Ｇ）的变化,并分析Ｃａ－ｊＯ２与Ｇａ－ｊ的关系。结果：两组Ｃａ－ｊＯ２与Ｇａ－ｊ于ＣＰＢ期间均进行性下降,与术前有显著性差异（Ｐ〈０．０１）;观察组Ｇ     

三磷酸腺苷与硝普钠控制性降压对血流动力学影响的比较

在30例中青年病人中,分组比较了 ATP 与 SNP 降压对血流动力学的影响。在两组中 MAP和 SVR 降低非常显著(P<0.01)。HR 增快和 CVP 降低在 SNP 组非常显著,而 ATP 组则无明显变化(P>0.05)。停药后10min MAP 和 SVR 在 ATP 组很快回到降压前水平,而 SNP 组则高于降压前和对照组水平(P<0.05)。     

安氟醚和硝酸甘油控制性降压对血流动力影响的对比研究

本文用无创性心阻抗血流图对比研究了50～60％N_2O-O_2-安氟醚麻醉下安氟醚和硝酸甘油控制性降压期间血流动力的变化。安氟醚降压期间 SI、CI 和 Heather 指数(HI)分别减少8.4～11.3％、4.7～10.6％和17.6～27.5％,TPR 下降21.9～26.1％,心率无明显增快;硝酸甘油降压中 TPR 下降34.7～38.9％,SI、CI 和 HI 分别增加2.7～6.1％、14.8～22.7％和12.6～14.5％,HR 代偿性增快12.4～13.8％。结论:安氟醚降压可用于 HR 较快、心功能良好的病人;硝酸甘油适用于年老、体弱、心功能欠佳的患者。     

Nimodipine attenuates lipid peroxidation during the acute phase of head trauma in rats

Oxygen free radical-mediated lipid peroxidation is one of the major mechanisms of secondary damage in traumatic brain injury. We assessed the effects of nimodipine on lipid peroxidation 1 h after head trauma in rats. Nimodipine (1.5 μg/kg IV bolus injection) was given immediately after head trauma by either the carotid artery or the jugular vein. Placebo treated rats received saline by the same routes. Control rats received head trauma only. Sham-operated rats were the group without head trauma. Malondialdehyde (MDA), which is the end product of lipid peroxidation, was measured as an indicator of oxygen free radical formation in the brain tissue. The mean values for MDA in sham operated rats were 92.4±4.9 nanomoles/gram wet weight (nmol/gww) of brain tissue. In the control group, MDA content of the brain tissue was 120.8±9.4 nmol/gww. In placebo treated rats, the results were similar. In the groups receiving nimodipine via carotid artery or jugular vein, the mean values were 101.1±6.9 and 106.5±6.0 nmol/gww, respectively. These results indicate that nimodipine caused a significant decrease in lipid peroxidation when given in the acute phase of head trauma in rats. This occurred regardless of the route of injection. Received: 16 August 1999 / Accepted: 27 December 1999     

硝酸甘油控制性低血压对罗库溴铵药效学的影响

目的探讨硝酸甘油控制性低血压对罗库溴铵量效关系和恢复时程的影响。方法50例全麻下择期手术,按手术顺序编号,采用随机数字表法分为控制性低血压(deliberate hypotension,DH)组和对照组,每组25例。采用四个成串刺激(TOF刺激)方式监测拇内收肌的收缩反应,记录麻醉手术期间罗库溴铵累计给药法的量效关系(ED50、ED90和ED95,即TOF中第一个肌颤搐(T1%)达到50%、90%和95%抑制所需剂量),追加药物时间间隔、峰效应时间、临床作用时间、作用总时间和恢复指数。结果DH组的ED50、ED90和ED95分别为(141.9±34.7)、(260.8±64.5)和(337.1±81.5)μg/kg,明显低于对照组[分别为(179.8±35.3)、(330.4±72.0)和(401.8±99.5)μg/kg](t=3.828,P=0.000;t=3.600,P=0.000;t=2.515,P=0.015)。DH组量效关系曲线的截距为-4.6±1.2,明显高于对照组-5.7±1.3(t=3.109,P=0.003)。与对照组比较,DH组达到最大抑制效应的时间较长[(2.8±0.6)minvs(2...     

体外循环期间尼莫地平对脑糖代谢的影响

目的　研究体外循环 ( CPB)中尼莫地平对脑糖代谢的影响。方法　选择 3 1例心脏直视手术病人 ,随机分为对照组 11例 ,观察组 2 0例。尼莫地平 4 0μg· kg- 1 于 CPB始缓慢注入体外循环机中 ,测定不同时期两组病人的动脉、颈内静脉上球部的血糖、丙酮酸、乳酸和乳酸脱氢酶 ( L DH) ,计算出脑糖摄取 GL U( a- v)、乳酸净剩余 ( L v- a)值。结果　 CPB过程中两组动脉、颈内静脉上球部的血糖、丙酮酸、乳酸和 L DH均进行性升高 ,两组 GL U( a- v)均低于 CPB前 ,但观察组明显高于对照组 ,两组L v- a无显著差异。结论　 CPB中尼莫地平明显提高脑糖利用 ,产生较多的能量以维持脑细胞功能的正常     

单肺通气下肺癌根治术患者血流动力学和血管外肺水的变化

目的 探讨单肺通气(OLV)是否为影响OLV下肺癌根治术患者术中、术后血管外肺水(EVLW)的独立因素.方法 20例因肺癌行肺叶切除术患者,术式相同,随机分为OLV组和双肺通气(TLV)组.所有患者均行股动脉穿刺并置入热敏导管,连接到脉搏指示剂连续心排出量(PiCCO)监护仪,记录手术开始前、通气30、60、120、150 min,术后1、3、5、20 h的中心静脉压(CVP)、心排出量(CO)、平均动脉压(MAP)、全身血管阻力指数(SVRI)、血管外肺水指数(EVLWI)等血流动力学指标.结果 两组间各血流动力学指标比较差异均无统计学意义.两组CO术中基本保持平稳,拔管前增加,拔管后稳定在较高水平(P＜0.05或P＜0.01);CVP术后1、3 h升高(P＜0.01);MAP术中升高,术后下降,但维持在高于术前的水平;SVRI在术前减低,术中升高,术后迅速回落至术前水平.EVLWI随时间延长呈逐渐降低趋势.结论 OLV对肺癌根治术患者EVLW影响轻微,是一项安全的麻醉操作.     

Cerebral and Systemic Effects of Hypotension Induced by Trimetaphan or Nitroprusside in Dogs

The effects of hypotension induced by trimetaphan (TMP) or nitroprusside (NTP) together with controlled haemorrhage on cerebral electrical activity, cerebrospinal fluid pressure (CSFP) and systemic circulatory and metabolic variables were measured in 10 mongrel dogs anaesthetized with halothane (end-tidal, 0.88±0.03%). Induced hypotension was maintained at cerebral perfusion pressure (CPP) of 45 mmHg for 45 min and then at 30 mmHg for 45 min. In five TMP dogs, there were significant decreases in EEG-power and slowing of peak power frequency from the frontal area, but not from the occipital area. The CSFP did not change significantly except for an increase during the induction stage of hypotension. In five NTP dogs, there were no significant changes in EEG-power and peak power frequency throughout the study from either frontal or occipital areas, but CSFP increased significantly. With both drugs, an increase in glucose, lactate and lactate pyruvate ratio (L/P), and a decrease in Pao₂ were more pronounced at 30 mmHg than 45 mmHg. With NTP, there were sustained increases in lactate and L/P, even after restoration of arterial pressure. The same magnitude and duration of the decrease in CPP induced by either TMP or NTP produced different effects on cerebral and systemic function.     

Effects of landiolol on the cardiovascular response during tracheal extubation

The objective of this study was to investigate the effect of landiolol on the cardiovascular responses to emergence from anesthesia and tracheal extubation. Fifty-nine patients without cardiovascular disorders who were scheduled for tympanoplasty were randomly allocated to receive a loading dose of landiolol at 0.125 mg x kg(-1) x min(-1) for 1 min, followed by an infusion at 0.01 mg x kg(-1) x min(-1) (group L1), 0.02 mg x kg(-1) x min(-1) (group L2), 0.03 mg x kg(-1) x min(-1) (group L3), or 0.04 mg x kg(-1) x min(-1) (group L4). At the end of surgery, sevoflurane and nitrous oxide were discontinued, and landiolol was started. The mean arterial pressure (MAP), heart rate (HR), and rate pressure product (RPP) in the four groups were compared before anesthesia induction, just after extubation, 5 min after extubation, 10 min after extubation, and at discharge from the operating room. Just after extubation compared with the baseline, the MAP increased significantly in all groups; the HR increased in groups L1 and L2; and the RPP increased in all groups, except for group L4. Continuous administration of landiolol, at 0.03 or 0.04 mg x kg(-1) x min(-1), may prevent the increases in HR and RPP, respectively, that occur at the emergence from anesthesia and tracheal extubation.     

小剂量多巴胺对腹腔镜围手术期肾功能及血流动力学的影响

目的探讨小剂量多巴胺对腹腔镜围手术期患者肾功能及血流动力学的影响。方法拟在腹腔镜下行全子宫切除手术40例,采用随机数字表随机分为多巴胺组（20例）和对照组（20例）。2组均采用静吸复合全身麻醉,多巴胺组在气腹前10min开始静脉持续泵注多巴胺（每分钟5μg/kg）直到手术结束,2组气腹前（T1）、气腹后60min（T2）和解除气腹后30min（T3）抽静脉血检测尿素氮（BUN）、肌酐（Cr）、尿酸（UA）,并记录心率（HR）、平均动脉压（MAP）,测量术中尿量。结果多巴胺组BUN、Cr、HR、MAP各时点无明显变化,UA于T2、T3时点明显降低,与T1及对照组相同时点的UA值比较差异有显著性（P〈0.05）,术中尿量明显多于对照组[（396±51）mlvs（121±15）ml,t=22.836,P=0.000];对照组气腹后60min（T2）HR减慢、MAP降低,与气腹前（T1）及同时间点多巴胺组比较差异有显著性（P〈0.05）。结论小剂量多巴胺可以降低血尿酸及增加尿量,改善肾功能,同时还可以有效维持患者血流动力学稳定。