Gallenberg L A, Stowe D F, Marijic J, Kampine J P, Bosnjak Z J
Department of Anesthesiology, Medical College of Wisconsin, Milwaukee.
Anesthesiology. 1991 Mar;74(3):519-30. doi: 10.1097/00000542-199103000-00022.
The direct effects of isoflurane, halothane, and enflurane alone or combined with diltiazem were examined in 49 isolated perfused guinea pig hearts. Recording electrodes were placed in the right atrium and left ventricular septal wall to measure spontaneous atrial rate and atrioventricular conduction time (AVCT). The right atrium was paced at 3-7 Hz (n = 10) to examine rate-dependent effects on AVCT, Wenckebach's periodicity, and ventricular response rates with atrioventricular (AV) block. Isovolumetric left ventricular pressure (LVP) was measured with a saline-filled balloon placed through the mitral valve. Hearts were perfused with oxygenated Krebs-Ringer's solution at 55 mmHg equilibrated with low or high concentrations of isoflurane (0.7 and 1.5%), halothane (0.5 and 1%), or enflurane (1.1 and 2.2%). Hearts were also perfused with a low or high concentration of diltiazem (75 and 150 ng/ml) alone and during anesthetic exposure. Significant findings of combined exposure were as follows: 1) the low isoflurane, halothane, or enflurane concentration plus a low or high diltiazem concentration decreased LVP compared with control and diltiazem alone; low isoflurane plus the high diltiazem concentration decreased LVP more than isoflurane alone. The high isoflurane, halothane, or enflurane concentration plus the low or the high diltiazem concentration decreased LVP from control, anesthetics and diltiazem alone. Diltiazem plus halothane or enflurane decreased LVP more than diltiazem plus isoflurane. 2) Diltiazem plus low or high isoflurane, halothane, or enflurane concentrations decreased spontaneous atrial rate from control and the agents alone, except the high isoflurane concentration plus the low diltiazem concentration was not greater than that of isoflurane alone. Diltiazem plus halothane or enflurane decreased atrial rate more than diltiazem plus isoflurane. 3) Low and high diltiazem concentration plus low isoflurane, halothane, or enflurane concentrations did not prolong AVCT more than the individual agents alone, but low or high diltiazem plus high isoflurane, halothane, or enflurane concentrations increased AVCT more than each anesthetic alone. In nonpaced hearts, AV block occurred only with high diltiazem plus low enflurane (23%) concentrations and the high enflurane concentration (31%). 4) In hearts paced at 5 and 6 Hz, AVCT increased above controls during a low or high concentrations of diltiazem, during enflurane, and during the low or high concentration of diltiazem plus enflurane; AVCT increased more with the low concentration of diltiazem plus enflurane than with the low diltiazem concentration alone.(ABSTRACT TRUNCATED AT 400 WORDS)
在49个离体灌注豚鼠心脏中研究了异氟烷、氟烷和恩氟烷单独使用或与地尔硫䓬联合使用的直接作用。记录电极置于右心房和左心室间隔壁，以测量自发心房率和房室传导时间（AVCT）。右心房以3 - 7 Hz的频率起搏（n = 10），以研究对AVCT、文氏周期以及房室（AV）阻滞时心室反应率的频率依赖性影响。通过经二尖瓣放置的充满盐水的球囊测量左心室等容压力（LVP）。心脏用含氧的 Krebs - Ringer 溶液灌注，该溶液在55 mmHg下用低或高浓度的异氟烷（0.7%和1.5%）、氟烷（0.5%和1%）或恩氟烷（1.1%和2.2%）平衡。心脏还单独用低或高浓度的地尔硫䓬（75和150 ng/ml）灌注以及在麻醉暴露期间灌注。联合暴露的重要发现如下：1）低浓度的异氟烷、氟烷或恩氟烷加上低或高浓度的地尔硫䓬与对照和单独使用地尔硫䓬相比降低了LVP；低浓度异氟烷加上高浓度地尔硫䓬比单独使用异氟烷更降低LVP。高浓度的异氟烷、氟烷或恩氟烷加上低或高浓度的地尔硫䓬与对照、单独使用麻醉剂和单独使用地尔硫䓬相比降低了LVP。地尔硫䓬加氟烷或恩氟烷比地尔硫䓬加异氟烷更降低LVP。2）地尔硫䓬加低或高浓度的异氟烷、氟烷或恩氟烷与对照和单独使用这些药物相比降低了自发心房率，除了高浓度异氟烷加低浓度地尔硫䓬不大于单独使用异氟烷。地尔硫䓬加氟烷或恩氟烷比地尔硫䓬加异氟烷更降低心房率。3）低和高浓度的地尔硫䓬加上低浓度的异氟烷、氟烷或恩氟烷不会比单独使用这些药物更延长AVCT，但低或高浓度的地尔硫䓬加 高浓度的异氟烷、氟烷或恩氟烷比单独使用每种麻醉剂更增加AVCT。在非起搏心脏中，仅在高浓度地尔硫䓬加低浓度恩氟烷（23%）和高浓度恩氟烷（31%）时发生AV阻滞。4）在以5和6 Hz起搏的心脏中，在低或高浓度的地尔硫䓬、恩氟烷以及低或高浓度的地尔硫䓬加恩氟烷期间，AVCT高于对照增加；低浓度地尔硫䓬加恩氟烷比单独使用低浓度地尔硫䓬时AVCT增加更多。（摘要截断于400字）
