Grundmann U, Ziehmer M, Raahimi H, Altmayer P, Larsen R, Büch H P
Klinik für Anästhesiologie und Intensivmedizin, Universität des Saarlandes, Homburg/Saar.
Anasthesiol Intensivmed Notfallmed Schmerzther. 1992 Nov;27(7):406-13. doi: 10.1055/s-2007-1000324.
In 40 patients with normal liver function total hepatic blood flow (HBF) was determined by the indocyanine-green clearance method simultaneously with haemodynamic parameters, including cardiac output by means of the noninvasive thoracic electrical bioimpedance method. Furthermore, the influence of halothane, enflurane or isoflurane on HBF and the interaction with haemodynamic parameters was studied. HBF and the cardiocirculatory parameters were determined under normal conditions (waking state) and the 40 patients were then divided into 4 groups (each n = 10). After standardised induction of anaesthesia (0.3 mg/kg etomidate and 2 micrograms/kg fentanyl) and tracheal intubation (1.5 mg/kg suxamethonium chloride) an inhalation anaesthesia in O2/air under control of normal end tidal carbon dioxide concentration was performed by intermittent positive pressure ventilation. Anaesthesia was maintained in the 4 groups either with 1 MAC halothane, 1 MAC enflurane, 1 MAC isoflurane or 1.3 MAC isoflurane. The measurements were repeated at a steady of the desired end expiratory concentration of the respective volatile anaesthetic. All three anaesthetics produced a significant and comparable decrease of cardiac output and arterial blood pressure. Differences between halothane, enflurane and isoflurane in respect of haemodynamic parameters were only minimal. Contrariwise, marked differences could be seen in the effects of the anaesthetics on HBF. In the presence of halothane and enflurane HBF dropped to 58% and 56% resp. of the control value, whereas during isoflurane anaesthesia HBF remained unchanged. Furthermore, only during halothane anaesthesia a significant correlation between arterial blood pressure and HBF could be observed indicating a loss of autoregulation of the hepatic blood flow.
对40例肝功能正常的患者，采用吲哚菁绿清除法测定其肝总血流量（HBF），同时采用无创胸电阻抗法测定包括心输出量在内的血流动力学参数。此外，研究了氟烷、恩氟烷或异氟烷对HBF的影响及其与血流动力学参数的相互作用。在正常条件下（清醒状态）测定HBF和心血管循环参数，然后将40例患者分为4组（每组n = 10）。在标准化诱导麻醉（0.3mg/kg依托咪酯和2μg/kg芬太尼）和气管插管（1.5mg/kg琥珀酰胆碱）后，通过间歇正压通气在正常呼气末二氧化碳浓度控制下于O2/空气中进行吸入麻醉。4组患者分别用1MAC氟烷、1MAC恩氟烷、1MAC异氟烷或1.3MAC异氟烷维持麻醉。在达到各自挥发性麻醉剂所需呼气末浓度稳定状态时重复测量。所有三种麻醉剂均使心输出量和动脉血压显著且同等程度降低。氟烷、恩氟烷和异氟烷在血流动力学参数方面的差异极小。相反地，可观察到麻醉剂对HBF的影响存在显著差异。在氟烷和恩氟烷作用下，HBF分别降至对照值的58%和56%，而异氟烷麻醉期间HBF保持不变。此外，仅在氟烷麻醉期间可观察到动脉血压与HBF之间存在显著相关性，表明肝血流自动调节功能丧失。
