Bourreli B, Pinaud M, Passuti N, Gunst J P, Drouet J C, Remi J P
Département d'Anesthésiologie, Centre Hospitalier Universitaire, Nantes, France.
Can J Anaesth. 1988 May;35(3 ( Pt 1)):242-8. doi: 10.1007/BF03010617.
Sixteen patients (13-38 yr) undergoing spinal fusion for scoliosis under controlled hypotension were studied to determine the haemodynamic and neuroendocrine responses to IV dihydralazine (1.0 mg.kg-1) followed by 0.5 and 1 MAC of enflurane or isoflurane. Twenty minutes after dihydralazine administration mean arterial pressure (-20 per cent) and systemic vascular resistance (-50 per cent) decreased, and cardiac index (+57 per cent), heart rate (+37 per cent) and intrapulmonary shunt increased. Plasma renin activity and aldosterone and norepinephrine levels increased. Further decreases in mean arterial pressure and in systemic vascular resistance were observed when 0.5 MAC enflurane or isoflurane were added. With 1 MAC anaesthetic levels a further decrease in mean arterial pressure was observed in both groups, but pressure fell to a lower level with isoflurane than with enflurane (p less than 0.01). The reduction of arterial blood pressure to a level of 50-60 mmHg for three to four hours was easy to control and was free of complications. The preliminary IV administration of dihydralazine allowed a reduced volatile agent concentration which attenuated undesirable haemodynamic effects, in spite of renin and norepinephrine release, and permitted a rapid intraoperative awakening.
对16例（年龄13 - 38岁）因脊柱侧凸接受脊柱融合术且处于控制性低血压状态的患者进行了研究，以确定静脉注射双肼屈嗪（1.0 mg·kg⁻¹）后，再给予0.5和1 MAC的恩氟烷或异氟烷时的血流动力学和神经内分泌反应。给予双肼屈嗪20分钟后，平均动脉压（下降20%）和全身血管阻力（下降50%）降低，心脏指数（增加57%）、心率（增加37%）和肺内分流增加。血浆肾素活性、醛固酮和去甲肾上腺素水平升高。当添加0.5 MAC的恩氟烷或异氟烷时，平均动脉压和全身血管阻力进一步降低。在1 MAC麻醉水平时，两组的平均动脉压均进一步降低，但异氟烷组的血压降至比恩氟烷组更低的水平（p < 0.01）。将动脉血压降至50 - 60 mmHg并维持三到四个小时易于控制且无并发症。尽管有肾素和去甲肾上腺素释放，但双肼屈嗪的预先静脉给药可降低挥发性麻醉药浓度，减轻不良血流动力学效应，并允许术中快速苏醒。
