Ueda T, Mizuguchi K, Tsuji T, Tabayashi N, Abe T, Naito H, Takewa Y, Taniguchi S
Department of Surgery III, Nara Medical University, Kashihara, Japan.
Int J Artif Organs. 2001 Jan;24(1):30-3.
In hypothermic cardiopulmonary bypass (CPB), various vasodilators are used to control the perfusion pressure. These agents, however, often decrease the pressure excessively, and the low perfusion pressure may persist until the end of CPB. In this study we evaluate the safety and characteristics of the regulation of perfusion pressure during CPB using a volatile anesthetic, sevoflurane which has an extremely low partition coefficient. Twenty adult patients who underwent cardiac surgery were studied. Sevoflurane was applied by a vaporizer inserted into the oxygenator gas supply line. Pump flows were fixed at 2.4 L/min/m2 during the hypothermic period. Sevoflurane concentration was adjusted to keep mean arterial pressure (MAP) between 40 and 70 mmHg during CPB. Hemodynamic and metabolic parameters were measured and compared to the group we previously treated with chlorpromazine. In all cases, MAP could be maintained adequately. In the sevoflurane group, systemic vascular resistance indices (SVRI) during the rewarming period and at the end of CPB were higher, and doses of norepinephrine needed at the end of CPB were significantly lower than in the chlorpromazine group. The regulation of perfusion pressure during CPB using sevoflurane was safe and could easily maintain adequate SVRI.
在低温体外循环（CPB）中，使用各种血管扩张剂来控制灌注压力。然而，这些药物常常会过度降低压力，并且低灌注压力可能会持续到CPB结束。在本研究中，我们评估了使用具有极低分配系数的挥发性麻醉剂七氟醚在CPB期间调节灌注压力的安全性和特点。对20例接受心脏手术的成年患者进行了研究。七氟醚通过插入氧合器气体供应管路的蒸发器给药。在低温期间泵流量固定为2.4L/（min·m²）。在CPB期间调整七氟醚浓度以将平均动脉压（MAP）维持在40至70mmHg之间。测量血流动力学和代谢参数，并与我们之前用氯丙嗪治疗的组进行比较。在所有病例中，MAP均可得到充分维持。在七氟醚组中，复温期和CPB结束时的全身血管阻力指数（SVRI）较高，并且CPB结束时所需的去甲肾上腺素剂量明显低于氯丙嗪组。在CPB期间使用七氟醚调节灌注压力是安全的，并且可以轻松维持足够的SVRI。
