Greene E S, Gerson J I
Anesthesiology. 1986 Feb;64(2):230-7. doi: 10.1097/00000542-198602000-00017.
Previous studies on halothane's effect on left ventricular diastolic compliance (LVDC) not only have had conflicting results, but are not directly applicable to most intraoperative settings. Therefore, the authors examined in dogs whether the depth of halothane anesthesia alters LVDC under surgical conditions over a wide range of hemodynamic stresses with the cardiovascular reflexes intact. The left ventricular diastolic pressure-volume relation was examined at 1 MAC and 2 MAC halothane in seven dogs over wide ranges of preload and afterload during left thoracotomy. Pulmonary capillary wedge pressure (PCWP), left ventricular end-diastolic pressure (LVEDP), and echocardiographic left ventricular end-diastolic volume (LVEDV) were analyzed with the exponential pressure-volume relation P = AeBV (where P = pressure, V = volume, and A and B are empirically derived coefficients). Multivariate analysis showed no significant differences for diastolic pressure-volume relations, comparing both levels of halothane using either PCWP or LVEDP for pressure. The authors conclude that in the intact cardiovascular system in the healthy open-chest dog: 1) LVDC does not change with the depth of halothane between 1 and 2 MAC (it is still possible LVDC changed between 0 and 1 MAC), and 2) PCWP does reflect the LVEDV during halothane anesthesia (between 1 and 2 MAC) under surgical conditions over a wide range of cardiovascular stresses.
以往关于氟烷对左心室舒张顺应性(LVDC)影响的研究不仅结果相互矛盾,而且并不直接适用于大多数术中情况。因此,作者在狗身上研究了在心血管反射完整的情况下,在广泛的血流动力学应激条件下,手术过程中氟烷麻醉深度是否会改变LVDC。在开胸手术中,对7只狗在1MAC和2MAC氟烷浓度下,在广泛的前负荷和后负荷范围内检查左心室舒张压力-容积关系。用指数压力-容积关系P = AeBV(其中P =压力,V =容积,A和B是根据经验得出的系数)分析肺毛细血管楔压(PCWP)、左心室舒张末期压力(LVEDP)和超声心动图左心室舒张末期容积(LVEDV)。多变量分析显示,使用PCWP或LVEDP作为压力指标,比较两种氟烷浓度下的舒张压力-容积关系,无显著差异。作者得出结论,在健康开胸狗的完整心血管系统中:1)在1MAC至2MAC之间,LVDC不会随氟烷深度而改变(0至1MAC之间仍有可能发生改变),2)在手术条件下,在广泛的心血管应激范围内,PCWP在氟烷麻醉期间(1至2MAC之间)确实反映了LVEDV。