MacIntyre A, Garnett L
Department of Anesthesia, Ottawa Civic Hospital, Ontario.
Can J Anaesth. 1991 Oct;38(7):926-30. doi: 10.1007/BF03036976.
We describe successful elective abdominal aneurysm repair in a patient with a cardiac transplant. In light of the unique physiology and pharmacology of the denervated heart, this presented an unusual combination of complex problems. Whereas the normally innervated heart increases cardiac output via neural stimuli, the denervated heart relies primarily on the Frank Starling mechanism which is dependent on preload and myocardial contractility. Thus, rapidly changing haemodynamic variables associated with aortic cross-clamping require scrupulous attention to the maintenance of adequate preload as well as myocardial function which can only be manipulated by direct-acting agents. We conclude that the denervated heart will readily compensate for the haemodynamic changes brought about by infrarenal aortic crossclamping if a high-normal preload is maintained and if the transplanted donor heart is free of pathology with good inherent myocardial contractility.
我们描述了一例心脏移植患者成功进行择期腹主动脉瘤修复的病例。鉴于去神经心脏独特的生理学和药理学特性，这带来了一系列复杂问题的不寻常组合。正常情况下，有神经支配的心脏通过神经刺激增加心输出量，而去神经心脏主要依赖于Frank Starling机制，该机制依赖于前负荷和心肌收缩力。因此，与主动脉交叉钳夹相关的快速变化的血流动力学变量需要格外注意维持足够的前负荷以及心肌功能，而这只能通过直接作用药物来调节。我们得出结论，如果维持较高的正常前负荷，并且移植的供体心脏没有病变且具有良好的固有心肌收缩力，去神经心脏将很容易补偿肾下腹主动脉交叉钳夹所带来的血流动力学变化。
