Alvarez J, Casas J I, Villar Landeira J M
Servicio de Anestesiología, Reanimación y Clínica del Dolor, Hospital de la Santa Creu i Sant Pau.
Rev Esp Anestesiol Reanim. 1990 May-Jun;37(3):127-36.
We evaluated the effects of the use of 1.2% isoflurane (group A) in a group of patients (n = 13) referred for mitral valve surgery, with pulmonary hypertension and right ventricular failure. We evaluated the hemodynamic status in baseline conditions, after isoflurane ++ administration and in relative hyper- and hypovolemia. We compared the results with those in 17 patients (group B) in identical clinical state who did not receive isoflurane during anesthesia. The evaluated parameters were: mixed venous Hb saturation (SvO2), heart rate (HR), pulmonary capillary pressure (PCP), central venous pressure (CVP), mean blood pressure (mBP), mean pulmonary arterial pressure (mPAP), cardiac index (CI), arteriolar pulmonary resistances (APR), peripheral vascular resistances (SVR), stroke index (SI), left ventricular work (LVW), right ventricular work (RVW), and O2 consumption (VO2). In group A, after isoflurane ++ administration, CI was 107.05% and 80% of baseline values in relative hypervolemia and hypovolemia, respectively. In group B (control), CI was 121.48% and 88.28% of basal values in relative hypervolemia and hypovolemia, respectively. In group A, SVR were 73.59% and 76.72% in hypervolemia and hypovolemia, respectively, while in group B they were 86.21% and 106.80%. In group A, APR were 90.85% and 89.96% in hypervolemia and hypovolemia, while they were 80.72% and 102.34% in group B. We found that isoflurane results in a greater peripheral than pulmonary vasodilation with a greater impairment in right ventricular function.
我们评估了在一组因二尖瓣手术前来就诊、患有肺动脉高压和右心室衰竭的患者（n = 13）中使用1.2%异氟烷（A组）的效果。我们评估了基线状态、异氟烷++给药后以及相对高血容量和低血容量时的血流动力学状态。我们将结果与17名处于相同临床状态、麻醉期间未接受异氟烷的患者（B组）的结果进行了比较。评估的参数包括：混合静脉血红蛋白饱和度（SvO2）、心率（HR）、肺毛细血管压（PCP）、中心静脉压（CVP）、平均血压（mBP）、平均肺动脉压（mPAP）、心脏指数（CI）、肺小动脉阻力（APR）、外周血管阻力（SVR）、每搏指数（SI）、左心室作功（LVW）、右心室作功（RVW）和氧耗量（VO2）。在A组中，异氟烷++给药后，在相对高血容量和低血容量时，CI分别为基线值的107.05%和80%。在B组（对照组）中，在相对高血容量和低血容量时，CI分别为基础值的121.48%和88.28%。在A组中，高血容量和低血容量时SVR分别为73.59%和76.72%，而在B组中分别为86.21%和106.80%。在A组中，高血容量和低血容量时APR分别为90.85%和89.96%，而在B组中分别为80.72%和102.34%。我们发现，异氟烷导致外周血管舒张大于肺血管舒张，且对右心室功能的损害更大。
