Murat I, Delleur M M, Loose J P, Saint-Maurice C
Cah Anesthesiol. 1986 Mar-Apr;34(2):117-24.
Eighteen young patients (mean age +/- SD 15.9 +/- 3.3) scheduled for operative treatment of idiopathic scoliosis (posterior spine fusion) were studied during surgery. Deliberate hypotension (MAP less than 60 mm Hg) of long duration (greater than 2 hours) was induced using isoflurane and nitroglycerin. Hypotension was effective in less than 15 min in all patients. The mean inspiratory fraction of isoflurane employed was 2.04 +/- 0.19% for the first operative hour, and 1.36 +/- 0.20% for the second operative hour. The difference between these inspiratory fractions is highly significant (p less than 0.001), while the rate of nitroglycerin infusion was unchanged (3 micrograms X kg-1 X min-1). Heart rate increases significantly at H1 and H2 when compared to preinduction values and the product of heart rate X systolic blood pressure decreases significantly with a mean of 30% versus preinduction values. A satisfactory operative field was obtained in all cases. Blood loss was dependent of the duration of surgery, of the total blood volume of the patient, of the length of spine fusion. For each patient, a slope of blood loss was established. The mean slope was 3.74 +/- 0.39 ml X kg-1 X h-1. The determination of the slope at the end of the first operative hour allows us to predict the total blood loss during surgery. Intra operative awakening was obtained 22.8 +/- 3.7 min after isoflurane was discontinued. Isoflurane and nitroglycerin produce a stable and safe hypotension with no major hemodynamic disturbances. Isoflurane has to be discontinued 20 min before the wake-up test.
18例计划接受特发性脊柱侧弯手术治疗（后路脊柱融合术）的年轻患者在手术过程中接受了研究。使用异氟烷和硝酸甘油诱导长时间（超过2小时）的控制性低血压（平均动脉压低于60 mmHg）。所有患者在不到15分钟内低血压起效。第一个手术小时使用的异氟烷平均吸入分数为2.04±0.19%，第二个手术小时为1.36±0.20%。这些吸入分数之间的差异非常显著（p<0.001），而硝酸甘油输注速率不变（3μg·kg-1·min-1）。与诱导前值相比，心率在H1和H2时显著增加，心率×收缩压乘积与诱导前值相比显著下降，平均下降30%。所有病例均获得了满意的手术视野。失血量取决于手术持续时间、患者总血容量、脊柱融合长度。为每位患者确定了失血斜率。平均斜率为3.74±0.39 ml·kg-1·h-1。在第一个手术小时结束时确定斜率可使我们预测手术期间的总失血量。停用异氟烷后22.8±3.7分钟实现术中苏醒。异氟烷和硝酸甘油可产生稳定、安全的低血压，且无重大血流动力学干扰。在苏醒试验前20分钟必须停用异氟烷。
