Goertz A, Heinrich H, Seeling W
Universitätsklinik für Anaesthesiologie, Universität Ulm, Germany.
Anaesthesia. 1992 Nov;47(11):984-7. doi: 10.1111/j.1365-2044.1992.tb03206.x.
Baroreflex control of heart rate after cardiac sympathectomy induced by thoracic epidural anaesthesia was evaluated in 30 patients who were randomly assigned to group 1 (bupivacaine 0.25%), group 2 (bupivacaine 0.5%) or group 3 (control). Plasma volume expanders were given to equalize preload conditions, as assessed using transoesophageal echocardiography. All measurements were made under general anaesthesia. Baroreflex sensitivity was determined from the heart rate response to phenylephrine and nitroglycerin. There was no difference in cardiac slowing in response to phenylephrine between the three groups. Baroreflex sensitivity, measured as cardiac acceleration in response to nitroglycerin, was significantly lower (p < 0.01) in groups 1 and 2 (1.8 and 1.5 ms.mmHg-1 respectively) compared with group 3 (3.5 ms.mmHg-1) with no differences between the two bupivacaine concentrations. The results suggest that baroreflex-mediated response to decreases in arterial pressure is dependent on the integrity of the sympathetic nervous system.
在30例患者中评估了胸段硬膜外麻醉诱导心脏交感神经切除术后压力感受器反射对心率的控制情况，这些患者被随机分为1组（0.25%布比卡因）、2组（0.5%布比卡因）或3组（对照组）。给予血浆容量扩充剂以平衡前负荷状态，通过经食管超声心动图进行评估。所有测量均在全身麻醉下进行。根据对去氧肾上腺素和硝酸甘油的心率反应来确定压力感受器反射敏感性。三组之间对去氧肾上腺素的心率减慢反应无差异。以对硝酸甘油的心率加速来衡量的压力感受器反射敏感性，1组和2组（分别为1.8和1.5毫秒·毫米汞柱⁻¹）显著低于3组（3.5毫秒·毫米汞柱⁻¹）（p < 0.01），两种布比卡因浓度之间无差异。结果表明，压力感受器反射介导的对动脉压降低的反应依赖于交感神经系统的完整性。
