Ionescu T I, Taverne R H, Houweling P, Schouten A N, Schimmel G, van der Tweel I, van Dijk A
Institute of Anesthesiology, Utrecht University Hospital, The Netherlands.
Acta Anaesthesiol Belg. 1989;40(1):65-77.
Thirty six comparable patients, ASA 2, without cardiac disease, underwent aortic disobliteration, 19 under epidural 100 micrograms/kg morphine (EM) and 17 under epidural 2 micrograms/kg sufentanil (ES), combined with general anesthesia. To compare the hemodynamics, measurements were taken pre-operatively, after induction of general anesthesia, during aortic dissection, aortic cross-clamping and 3-5 minutes after the first revascularisation. Plasma and CSF drug levels were measured at intervals in 6 patients in the EM end 5 patients in the ES group. Both drugs provided satisfactory analgesia which persisted for 10.4 hours in the EM and 6.3 hours in the ES group. The fall in systemic pressure and left ventricular work in both groups after induction of general anesthesia suggests that EM and ES must be used with caution in patients with hypovolemic or cardiovascular disease. There was a significant difference in SVR between the two groups during the aortic dissection, due to a rise in SBP in the ES group and a tendency for SVR to fall in the EM group. However significant differences in left ventricular work did not occur. Notable was the absence of significant changes in filling pressure, CI and left ventricular function during aortic cross-clamping. After revascularization a significant decrease in systolic blood pressure occurred in association with an increase in heart rate in the EM group. The influence of the plasma and CSF concentrations of morphine and sufentanil on the hemodynamic changes during surgery were evaluated.
36例ASA 2级、无心脏病的可比患者接受了主动脉再通术，其中19例接受硬膜外注射100微克/千克吗啡（EM），17例接受硬膜外注射2微克/千克舒芬太尼（ES），均联合全身麻醉。为比较血流动力学，在术前、全身麻醉诱导后、主动脉夹层分离期间、主动脉交叉钳夹时以及首次血管再通后3至5分钟进行测量。在EM组的6例患者和ES组的5例患者中定期测量血浆和脑脊液药物水平。两种药物均提供了满意的镇痛效果，EM组持续10.4小时，ES组持续6.3小时。全身麻醉诱导后两组的体循环压力和左心室做功下降表明，对于低血容量或心血管疾病患者，使用EM和ES时必须谨慎。在主动脉夹层分离期间，两组之间的体循环阻力存在显著差异，原因是ES组收缩压升高，而EM组体循环阻力有下降趋势。然而，左心室做功没有显著差异。值得注意的是，在主动脉交叉钳夹期间，充盈压、心脏指数和左心室功能没有显著变化。血管再通后，EM组收缩压显著下降，同时心率增加。评估了吗啡和舒芬太尼的血浆和脑脊液浓度对手术期间血流动力学变化的影响。
