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异氟烷和氟烷麻醉期间的肝脏循环与功能

Liver circulation and function during isoflurane and halothane anesthesia.

作者信息

Gelman S, Fowler K C, Smith L R

出版信息

Anesthesiology. 1984 Dec;61(6):726-30. doi: 10.1097/00000542-198412000-00017.

Abstract

Hepatic arterial blood flow (HABF) and portal blood flow (PBF) were measured in 18 dogs while awake and during isoflurane and halothane anesthesia. Surgical preparation 1 week before the measurements consisted of a left thoracotomy, placement of a left atrial catheter, and insertion of another catheter into the distal aorta via the left femoral artery. Cardiac output and liver blood flow were determined using microspheres at three stages: stage 1-awake state; stage 2-after 45 min of 1 MAC of isoflurane (eight dogs) or halothane (10 dogs) anesthesia; and stage 3-after 45 min of 2 MAC of inhalation anesthesia. Half-life and fractional clearance for indocyanine green (ICG) were determined 1 day before the experiment (awake state), and at the end of stages 2 and 3. Mean arterial pressure (MAP) and cardiac index (CI), as well as PBF, decreased during isoflurane and halothane anesthesia. HABF increased significantly during isoflurane anesthesia, remained unchanged during 1 MAC of halothane anesthesia, and significantly decreased during 2 MAC of halothane anesthesia. Apparently, hepatic oxygen supply was maintained much better during isoflurane than during halothane anesthesia. PBF correlated with CI during halothane (r = 0.97) and, to a certain extent, with MAP during isoflurane (r = 0.66). HABF correlated with CI and MAP during halothane (r = 0.74 and 0.71, respectively) but did not correlate with systemic hemodynamic variables during isoflurane. ICG half-life significantly increased during 1 and 2 MAC of halothane anesthesia. The degree of increase did not correlate with the level of anesthesia or the decrease in total hepatic blood flow.(ABSTRACT TRUNCATED AT 250 WORDS)

摘要

在18只清醒犬以及异氟烷和氟烷麻醉期间测量肝动脉血流量(HABF)和门静脉血流量(PBF)。测量前1周的手术准备包括左胸廓切开术、左心房导管置入以及经左股动脉将另一根导管插入远端主动脉。在三个阶段使用微球测定心输出量和肝血流量:阶段1——清醒状态;阶段2——异氟烷(8只犬)或氟烷(10只犬)1MAC麻醉45分钟后;阶段3——吸入麻醉2MAC 45分钟后。在实验前1天(清醒状态)以及阶段2和3结束时测定吲哚菁绿(ICG)的半衰期和分数清除率。在异氟烷和氟烷麻醉期间,平均动脉压(MAP)、心脏指数(CI)以及PBF均下降。异氟烷麻醉期间HABF显著增加,氟烷1MAC麻醉期间保持不变,氟烷2MAC麻醉期间显著下降。显然,异氟烷麻醉期间肝氧供应比氟烷麻醉期间维持得更好。氟烷麻醉期间PBF与CI相关(r = 0.97),异氟烷麻醉期间在一定程度上与MAP相关(r = 0.66)。氟烷麻醉期间HABF与CI和MAP相关(分别为r = 0.74和0.71),但异氟烷麻醉期间与全身血流动力学变量不相关。氟烷1MAC和2MAC麻醉期间ICG半衰期显著增加。增加程度与麻醉水平或肝总血流量减少无关。(摘要截短于250字)

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