Priebe H J
Department of Anesthesia, University Hospital Freiburg, Federal Republic of Germany.
Anesthesiology. 1989 Dec;71(6):885-92. doi: 10.1097/00000542-198912000-00012.
The effects of acute right ventricular (RV) hypertension (RVH) induced by pulmonary artery (PA) constriction, and of two concentrations (mean inspired 0.8 and 1.5%) of halothane (HAL) during RVH on global and regional RV performance (ultrasonic dimension technique), and on coronary hemodynamics (electromagnetic flow probes) were studied in 12 open-chest dogs anesthetized and paralyzed by continuous infusions of fentanyl and pancuronium. Following PA constriction, RV systolic pressure more than doubled, RV end-diastolic and systolic dimensions increased, and stroke volume (SV) and segment shortening fell (P all less than 0.05). There was no evidence of regional myocardial dysfunction (i.e., akinesis, systolic lengthening, postsystolic shortening), and reactive hyperemia in response to right coronary artery occlusion was present. Subsequent addition of HAL (0.8%) resulted in further increases in end-diastolic and systolic dimensions, and in marked decreases in right coronary blood flow, segment shortening, SV, and aortic pressure. During HAL 1.5% (range: 1.2-1.6%), regional myocardial dysfunction developed in three animals, reactive hyperemia was abolished in five out of six animals tested, and metabolic acidosis developed. Release of PA constriction during 1.5% HAL in seven animals resulted in improved global and regional RV performance, disappearance of regional myocardial dysfunction, and restoration of reactive hyperemia. In this canine model of acute RVH, increasing concentrations of HAL led to increasing deterioration in global and regional RV performance most likely due to inadequate coronary perfusion.
在12只通过持续输注芬太尼和潘库溴铵麻醉并麻痹的开胸犬中,研究了肺动脉(PA)缩窄诱导的急性右心室(RV)高血压(RVH)的影响,以及RVH期间两种浓度(平均吸入0.8%和1.5%)的氟烷(HAL)对整体和局部RV功能(超声尺寸技术)以及冠状动脉血流动力学(电磁血流探头)的影响。PA缩窄后,RV收缩压增加了一倍多,RV舒张末期和收缩期尺寸增加,每搏输出量(SV)和节段缩短率下降(P均小于0.05)。没有区域心肌功能障碍的证据(即运动不能、收缩期延长、收缩后缩短),并且存在对右冠状动脉闭塞的反应性充血。随后添加HAL(0.8%)导致舒张末期和收缩期尺寸进一步增加,右冠状动脉血流量、节段缩短率、SV和主动脉压显著降低。在HAL 1.5%(范围:1.2 - 1.6%)期间,三只动物出现区域心肌功能障碍,六只受试动物中有五只的反应性充血消失,并且出现代谢性酸中毒。七只动物在1.5% HAL期间解除PA缩窄导致整体和局部RV功能改善、区域心肌功能障碍消失以及反应性充血恢复。在这个急性RVH犬模型中,HAL浓度增加导致整体和局部RV功能恶化加剧,最可能的原因是冠状动脉灌注不足。