Kieler-Jensen N, Jolin-Mellgård A, Nordlander M, Ricksten S E
Department of Anaesthesia and Intensive Care, Sahlgrenska University Hospital, Göteborg, Sweden.
Acta Anaesthesiol Scand. 2000 Feb;44(2):186-93. doi: 10.1034/j.1399-6576.2000.440210.x.
The aim was to evaluate the use of clevidipine, a new vascular selective, ultra-short-acting calcium antagonist for blood pressure control after coronary artery bypass grafting (CABG).
The effects of clevidipine on central hemodynamics, myocardial blood flow and metabolism were studied at two different phases after CABG. In phase 1 (n=13), the hypertensive phase, the effects of clevidipine were compared to those of sodium nitroprusside (SNP) when used to control postoperative hypertension. In phase 2 (n=9), the normotensive phase, a clevidipine dose-response relationship was established.
At a target mean arterial pressure (MAP) of 75 mmHg, systemic vascular resistance (SVR) and heart rate (HR) were lower, preload, stroke volume (SV) and pulmonary vascular resistance (PVR) were higher, while there were no differences in myocardial lactate metabolism or oxygen extraction with clevidipine compared to SNP. In the normotensive phase, clevidipine induced a dose-dependent decrease in MAP (-19%), SVR (-27%) and PVR (-15%), accompanied by an increase in SV (10%), but no reflex increase in HR or changes in cardiac preload. Clevidipine caused a direct coronary vasodilation, as indicated by a decrease in myocardial oxygen extraction from 54% to 45%. Myocardial lactate metabolism was unaffected by clevidipine. The blood clearance of clevidipine was 0.05 l x min(-1) x kg(-1), the volume of distribution at steady state was 0.08 l x kg(-1) and the initial and terminal half-lives were <1 min and 4 min, respectively.
Clevidipine rapidly reduced MAP and induced a systemic, pulmonary and coronary vasodilation with no effect on venous capacitance vessels or HR. Clevidipine caused no adverse effects on myocardial lactate metabolism. Clevidipine thus appears suitable to control blood pressure after CABG.
目的是评估新型血管选择性超短效钙拮抗剂左西孟旦在冠状动脉旁路移植术（CABG）后控制血压方面的应用。
在CABG后的两个不同阶段研究了左西孟旦对中心血流动力学、心肌血流和代谢的影响。在第1阶段（n = 13），即高血压阶段，将左西孟旦用于控制术后高血压时的效果与硝普钠（SNP）进行比较。在第2阶段（n = 9），即血压正常阶段，建立左西孟旦的剂量反应关系。
在目标平均动脉压（MAP）为75 mmHg时，与SNP相比，左西孟旦使全身血管阻力（SVR）和心率（HR）降低，前负荷、每搏输出量（SV）和肺血管阻力（PVR）升高，而心肌乳酸代谢或氧摄取无差异。在血压正常阶段，左西孟旦使MAP（-19%）、SVR（-27%）和PVR（-15%）呈剂量依赖性降低，同时SV增加（10%），但HR无反射性增加或心脏前负荷无变化。左西孟旦引起直接冠状动脉血管舒张，表现为心肌氧摄取从54%降至45%。左西孟旦对心肌乳酸代谢无影响。左西孟旦的血液清除率为0.05 l x min(-1) x kg(-1)，稳态分布容积为0.08 l x kg(-1)，初始半衰期和终末半衰期分别<1分钟和4分钟。
左西孟旦迅速降低MAP并引起全身、肺和冠状动脉血管舒张，对静脉容量血管或HR无影响。左西孟旦对心肌乳酸代谢无不良影响。因此，左西孟旦似乎适合于CABG后控制血压。
