Lehot J J, Muchada R, George M, Ferrier C, Winnock S, Mercier M, Renaud A, Estanove S
Hôpital Cardio-vasculairé et pneumologique Louis Pradel, B.P. Lyon-Montchat, Lyon.
Cah Anesthesiol. 1989 Sep;37(5):319-26.
Most anaesthetic agents cause cardiac depression possibly hazardous in the elderly, especially in presence of a poor cardiac reserve. Ninety-three patients undergoing non cardiac surgery lasting more than 90 min. were entered in a double-blind multicentre randomized trial. They were 65 year old or more and unaffected by evolutive angina pectoris. After insertion of a Swan Ganz catheter and an arterial cannula, anaesthesia was induced by thiopentone, fentanyl and 02/nitrous oxide (50%). Forty-five patients were infused dobutamine 7 micrograms.kg-1.min-1 (group D) from 10 min. after induction till the completion of surgery. Forty-eight patients received a placebo (group P). Haemodynamic parameters were recorded throughout anaesthesia and at its emergence. After induction, heart rate, pulmonary capillary wedge pressure and mean pulmonary artery pressure did not change significantly; mean arterial pressure, cardiac index, stroke index and left ventricular stroke work index decreased by 21, 33, 28 and 42% respectively (p less than 0.001); systemic and pulmonary arterial resistances increased by 12 and 37% respectively (p less than 0.001). In group P, these changes persisted throughout the procedure but, 30 min after extubation, cardiac index returned to control levels due to a 25% increase in heart rate; in this group 4 patients presented with both perioperative low cardiac output and persistent postoperative confusion. With dobutamine, haemodynamic parameters returned to preoperative values and heart rate increased by 12 b.min-1. More arrhythmias and hypertensive episodes but less hypotensions occurred in group D. Substantial haemodynamic changes occur during anaesthesia and surgery in elderly patients. Dobutamine corrects the peroperative decrease in cardiac output and blood pressure, and might prevent postoperative neurological disorders.
大多数麻醉剂都会导致心脏抑制，这在老年人中可能具有危险性，尤其是在心脏储备功能较差的情况下。93例接受持续时间超过90分钟非心脏手术的患者进入了一项双盲多中心随机试验。他们年龄在65岁及以上，且未患进行性心绞痛。插入Swan Ganz导管和动脉插管后，用硫喷妥钠、芬太尼和氧气/氧化亚氮（50%）诱导麻醉。45例患者从诱导后10分钟开始至手术结束，以7微克·千克⁻¹·分钟⁻¹的速度输注多巴酚丁胺（D组）。48例患者接受安慰剂（P组）。在整个麻醉过程及其苏醒时记录血流动力学参数。诱导后，心率、肺毛细血管楔压和平均肺动脉压无明显变化；平均动脉压、心脏指数、每搏指数和左心室每搏功指数分别下降21%、33%、28%和42%（p<0.001）；全身和肺动脉阻力分别增加12%和37%（p<0.001）。在P组中，这些变化在整个手术过程中持续存在，但拔管后30分钟，由于心率增加25%，心脏指数恢复到对照水平；该组有4例患者出现围手术期低心输出量和持续的术后意识模糊。使用多巴酚丁胺后，血流动力学参数恢复到术前值，心率增加12次·分钟⁻¹。D组发生更多心律失常和高血压发作，但低血压较少。老年患者在麻醉和手术期间会出现显著的血流动力学变化。多巴酚丁胺可纠正手术期间的心输出量和血压下降，并可能预防术后神经功能障碍。
