Lynch C, Frazer M J
Department of Anesthesiology, University of Virginia Medical Center, Charlottesville 22908.
Anesthesiology. 1989 Mar;70(3):511-22. doi: 10.1097/00000542-198903000-00023.
To clarify the mechanisms by which volatile anesthetics may depress myocardial contractility, the depressant effects of equivalent concentrations of isoflurane, enflurane and halothane were compared in rat and frog ventricular myocardium, preparations which differ markedly in excitation-contraction coupling. In Tyrode solution, right ventricular papillary muscles from rat exhibited very large, rapidly developing contractions after rest, with a subsequent negative force-frequency relation as the stimulation rate was increased to 0.1, 0.25, 0.5, 1, 2, and 3 Hz. The large contractions after rest and at 0.1 Hz were depressed by 0.75% halothane and 1.7% enflurane to about 60% of control, but less so by 1.3% isoflurane (approximately 0.8 MAC). Halothane at 1.5% was more depressant than 2.5% isoflurane at all stimulation rates, while 3.5% enflurane caused intermediate depression (approximately 1.6 MAC). Contractions in frog ventricular strips were studied in Ringer solution following rest and at stimulation rates of 0.1, 0.25, 0.5, and 1 Hz, in the absence and presence of equivalent anesthetic concentrations. At 0.1 to 1 Hz, isoflurane was less depressant than equivalent concentrations of halothane. Enflurane (1.7%) was less depressant than 0.75% halothane at 0.1 and 0.25 Hz; 3.5% enflurane was more depressant than 2.5% isoflurane at 1 Hz. Anesthetic effects on sustained contractures were also studied in frog ventricular strips that were superfused for 4-5 min with 40, 60, 80, and 100 mM K Ringer solution. Contractures induced by 80 and 100 mM K solution were depressed more by halothane (to 60% of control) than by isoflurane or enflurane (approximately 85% of control). However, only enflurane depressed the contractions at 1 Hz more than the sustained contractures in 100 mM K Ringer. The Ca2+ for activating contractions in rat ventricle is derived largely from the sarcoplasmic reticulum, the intracellular Ca2+ accumulation and release organelle. In contrast, Ca2+ for activating contractions in the frog ventricle originates primarily from the external medium. These results suggest that halothane is more potent than isoflurane in reducing the amount of Ca2+ rapidly released from the sarcoplasmic reticulum (as observed in rat), as well as in depressing entry of extracellular Ca2+ to activate myofibrils (as in frog). Enflurane appears to have intermediate potency with actions distinct from halothane and isoflurane. The greater potency of halothane may also be due in part to greater direct depression of actin-myosin ATPase.
为阐明挥发性麻醉药可能抑制心肌收缩力的机制,在大鼠和青蛙心室肌中比较了等效浓度的异氟烷、恩氟烷和氟烷的抑制作用,这两种制剂在兴奋 - 收缩偶联方面有显著差异。在台氏液中,大鼠右心室乳头肌在静息后表现出非常大且迅速发展的收缩,随后随着刺激频率增加到0.1、0.25、0.5、1、2和3 Hz,出现负性力 - 频率关系。静息后及0.1 Hz时的大收缩被1.5%氟烷和1.7%恩氟烷抑制至对照的约60%,但1.3%异氟烷(约0.8 MAC)的抑制作用较小。在所有刺激频率下,1.5%氟烷比2.5%异氟烷的抑制作用更强,而3.5%恩氟烷引起中等程度的抑制(约1.6 MAC)。在林格液中,对青蛙心室条在静息后及0.1、0.25、0.5和1 Hz刺激频率下进行研究,分别在有无等效麻醉药浓度的情况下。在0.1至1 Hz时,异氟烷的抑制作用小于等效浓度的氟烷。在0.1和0.25 Hz时,1.7%恩氟烷的抑制作用小于0.75%氟烷;在1 Hz时,3.5%恩氟烷的抑制作用比2.5%异氟烷更强。还在青蛙心室条中研究了麻醉药对持续挛缩的影响,用40、60、80和100 mM K林格液灌流4 - 5分钟。由80和100 mM K溶液诱导的挛缩被氟烷(抑制至对照的60%)抑制的程度大于异氟烷或恩氟烷(约为对照的85%)。然而,只有恩氟烷在1 Hz时对收缩的抑制作用大于在100 mM K林格液中的持续挛缩。大鼠心室中激活收缩的Ca2+主要来自肌浆网,即细胞内Ca2+积累和释放的细胞器。相比之下,青蛙心室中激活收缩的Ca2+主要来自细胞外介质。这些结果表明,氟烷在减少从肌浆网快速释放的Ca2+量(如在大鼠中观察到的)以及抑制细胞外Ca2+进入以激活肌原纤维(如在青蛙中)方面比异氟烷更有效。恩氟烷似乎具有中等效力,其作用不同于氟烷和异氟烷。氟烷效力更强的部分原因可能还在于对肌动蛋白 - 肌球蛋白ATP酶的直接抑制作用更强。