Kim Y D, Danchek M, Myers A K, Burke T A, Analouei A, Miller D L, Moore S, Coughlin S, Visner M S
Department of Anesthesia, Georgetown University Medical Center, Washington, DC 20007.
Br J Anaesth. 1992 Mar;68(3):286-92. doi: 10.1093/bja/68.3.286.
During myocardial ischaemia, functional compensation occurs by non-ischaemic regions of the left ventricle (LV). Anaesthetics may affect compensation by altering contractility, metabolism and perfusion. This was studied in dogs anaesthetized with fentanyl (150 micrograms kg-1 loading dose and 100 micrograms kg-1 h-1) or 0.75% and 1.5% halothane and subjected to left anterior descending artery (LAD) occlusion. After 15 min of anterior wall ischaemia, cardiac output, mean arterial pressure and LV maximum dP/dt were diminished in the 1.5% halothane but not in the 0.75% halothane or fentanyl groups. In all groups, stroke volume decreased, LV end-diastolic pressure increased and anterior wall function deteriorated (measured as systolic shortening, peak systolic intramyocardial pressure (IMP), regional wall stroke work (RSW) and slope of preload recruitable stroke work curve (Mw)) with ischaemia. Functional changes in the lateral (non-ischaemic) wall were different between groups. Regional function during occlusion in this area improved with fentanyl (mean (SEM) IMP, RSW and Mw increased by 23 (2)%, 37 (3)% and 69 (7)%, respectively), was relatively well maintained with 0.75% halothane and diminished with 1.5% halothane.
在心肌缺血期间，左心室（LV）的非缺血区域会发生功能代偿。麻醉剂可能通过改变心肌收缩力、代谢和灌注来影响这种代偿。本研究以芬太尼（负荷剂量150微克/千克，维持剂量100微克/千克·小时）、0.75%和1.5%的氟烷麻醉犬，并对其左前降支动脉（LAD）进行结扎。在前壁缺血15分钟后，1.5%氟烷组的心输出量、平均动脉压和左心室最大dP/dt降低，而0.75%氟烷组和芬太尼组则未出现此现象。在所有组中，随着缺血的发生，每搏输出量减少，左心室舒张末期压力升高，前壁功能恶化（通过收缩期缩短、收缩期心肌内压峰值（IMP）、区域壁每搏功（RSW）和前负荷可调节每搏功曲线斜率（Mw）来衡量）。各组之间侧壁（非缺血）的功能变化有所不同。在此区域结扎期间，芬太尼组的区域功能有所改善（平均（SEM）IMP、RSW和Mw分别增加23（2）%、37（3）%和69（7）%），0.75%氟烷组相对维持良好，而1.5%氟烷组则降低。
