Zerkowski H R, Hellinger A, Pfeiffer T, Günnicker M
Abteilung für Thorax- und kardiovaskuläre Chirurgie, Universitätsklinikum Essen.
Klin Wochenschr. 1991;69 Suppl 26:129-33.
Perioperative circulatory disorders in patients may take the form of a transitory reduction in oxygen transport to the peripheral tissues (pre-shock), manifest circulatory insufficiency in the presence or absence of concomitant heart insufficiency or general congestive heart failure due to the destabilization of an preexisting heart disease. The least problematical stage in this programme of therapy is the treatment of transitory perioperative circulatory insufficiency by manipulation of the oxygen transport system using the following means: comparative volume optimization [according to the central venous pressure (CVP)], positive inotropic support with dobutamine (5-10 micrograms.kg-1.min-1), monitoring of the blood pressure, heart rate and oxygen consumption and, in severe cases, insertion of a Swan-Ganz catheter. In manifest circulatory insufficiency, sepsis or acute congestive heart failure, the Swan-Ganz catheter seems to be obligatory. In such cases, the positive inotropic therapy is based on catecholamines of medium (dobutamine) or high (epinephrine) positive inotropic efficacy, as a normal pattern and functioning of beta-adrenoceptors can be assumed in such cases if there is no history of cardiac insufficiency. The systemic vascular resistance (SVR) is adjusted to 800-1200 n.s.cm-5 to relieve the working capacity of the heart and to maintain sufficient perfusion pressure by means of constrictors (phenylephrine, norepinephrine) or dilators [nifedipine, nitroglycerin or, if necessary, angiotensin-converting-enzyme (ACE) inhibitors].(ABSTRACT TRUNCATED AT 250 WORDS)
患者围手术期循环障碍可能表现为短暂性的外周组织氧输送减少（休克前期），或因原有心脏病失稳，在伴有或不伴有心脏功能不全或全心性心力衰竭的情况下出现明显的循环功能不全。该治疗方案中最不成问题的阶段是通过以下方法调节氧输送系统来治疗短暂性围手术期循环功能不全：根据中心静脉压（CVP）进行容量比较优化，用多巴酚丁胺（5 - 10微克·千克⁻¹·分钟⁻¹）进行正性肌力支持，监测血压、心率和氧消耗，严重时插入Swan - Ganz导管。在明显的循环功能不全、脓毒症或急性充血性心力衰竭时，Swan - Ganz导管似乎是必需的。在这种情况下，正性肌力治疗基于中效（多巴酚丁胺）或高效（肾上腺素）正性肌力作用的儿茶酚胺，因为如果没有心脏功能不全病史，可假定此时β - 肾上腺素能受体功能正常。通过使用血管收缩剂（去氧肾上腺素、去甲肾上腺素）或血管扩张剂（硝苯地平、硝酸甘油，必要时使用血管紧张素转换酶抑制剂）将体循环血管阻力（SVR）调整到800 - 1200纳秒·厘米⁻⁵，以减轻心脏工作负荷并维持足够的灌注压。（摘要截断于250字）
