Blake D W, McGrath B P, Donnan G B, Smart S, Way D, Myers K A, Fullerton M
Department of Anaesthesia, Monash Medical Centre, Prince Henry's Hospital, Melbourne, Victoria, Australia.
Eur J Anaesthesiol. 1991 Sep;8(5):365-71.
Sixteen patients presenting for abdominal aortic surgery were divided into two groups according to whether or not there was a history and clinical evidence of chronic heart failure (CHF). Atrial natriuretic peptide (ANP) and catecholamines were measured during a preoperative exercise test and then with induction of anaesthesia and surgery. Patients in the CHF group (n = 8) had a much-reduced cardiac output (CO) rise in response to exercise compared to the control group (13% vs. 75%, P less than 0.05). This difference was due to the absence of a stroke volume increase in the CHF group. Induction of anaesthesia resulted in a greater fall in mean arterial pressure in the CHF group prior to the start of surgery, due to a greater fall in CO. Plasma ANP levels were higher in the CHF group at rest and at each exercise stage (P less than 0.05). ANP levels were not altered by induction of anaesthesia or intubation, but increased with the start of surgery in the CHF group (P less than 0.05). Increases in plasma catecholamine levels in response to exercise and to surgery were similar in the two groups. Changes in endogenous ANP may be important in counteracting the undesirable effects of vasoconstrictor hormones during physical exercise or surgical stress.
16名接受腹主动脉手术的患者根据是否有慢性心力衰竭（CHF）病史和临床证据被分为两组。在术前运动试验期间、麻醉诱导期及手术过程中测量心房利钠肽（ANP）和儿茶酚胺水平。与对照组相比，CHF组（n = 8）患者运动时心输出量（CO）的增加显著减少（13% 对 75%，P < 0.05）。这种差异是由于CHF组患者每搏输出量没有增加。由于CO下降幅度更大，麻醉诱导导致CHF组患者在手术开始前平均动脉压下降幅度更大。CHF组患者静息时及每个运动阶段的血浆ANP水平均较高（P < 0.05）。麻醉诱导或插管未改变ANP水平，但CHF组患者手术开始时ANP水平升高（P < 0.05）。两组患者运动及手术时血浆儿茶酚胺水平的升高相似。内源性ANP的变化可能在抵消体育锻炼或手术应激期间血管收缩激素的不良影响方面起重要作用。
