Sunada K, Nakamura K, Yamashiro M, Sumitomo M, Furuya H
Department of Anesthesiology, Nippon Dental University, School of Dentistry at Tokyo, Japan.
Anesth Prog. 1996 Fall;43(4):108-15.
Hemodynamic changes were evaluated in patients with essential hypertension when felypressin of various concentrations was administered. The parameters studied were systolic pressure, diastolic pressure, heart rate, left ventricular systolic phase, and endocardial viability ratio. Results showed that blood pressure tended to increase, and the value of 1/pre-ejection period2 (PEP2) tended to decrease, upon administration of 3 ml of 2% propitocaine containing 0.06 international units/ml (IU/ml) of felypressin. Significant increase of blood pressure and decrease in 1/PEP2 was noted upon administration of 3 ml of anesthetic solution containing 0.13 IU/ml of felypressin. No ischemic change of the myocardium was detected even with the highest felypressin concentration (3 ml of 2% propitocaine containing 0.25 IU/ml of felypressin). These results suggest that the clinically safe dosage of felypressin for patients with essential hypertension is approximately 0.18 IU. This amount is equivalent to 6 ml of 3% propitocaine with 0.03 IU/ml of felypressin, which is a commercially available local anesthetic for dental use. It seems that the decrease in 1/PEP2 that occurred during blood pressure increase was due to the increase in afterload caused by contraction of the arterioles. Although in the present study no ischemic change was noted, special care should be taken to prevent myocardial ischemia in patients with severe hypertension.
在原发性高血压患者中，当给予不同浓度的垂体后叶加压素时，对血流动力学变化进行了评估。研究的参数包括收缩压、舒张压、心率、左心室收缩期和心内膜活力比。结果显示，给予3毫升含0.06国际单位/毫升（IU/ml）垂体后叶加压素的2%丙胺卡因后，血压有升高趋势，1/射血前期2（PEP2）值有降低趋势。给予3毫升含0.13 IU/ml垂体后叶加压素的麻醉溶液后，血压显著升高，1/PEP2降低。即使使用最高浓度的垂体后叶加压素（3毫升含0.25 IU/ml垂体后叶加压素的2%丙胺卡因），也未检测到心肌缺血变化。这些结果表明，原发性高血压患者垂体后叶加压素的临床安全剂量约为0.18 IU。该剂量相当于6毫升含0.03 IU/ml垂体后叶加压素的3%丙胺卡因，这是一种市售的牙科局部麻醉剂。血压升高期间出现的1/PEP2降低似乎是由于小动脉收缩导致后负荷增加所致。尽管在本研究中未观察到缺血变化，但对于重度高血压患者，应特别注意预防心肌缺血。
