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[麻醉期间血流动力学状态的批判性研究]

[Critical study of the hemodynamic status during anesthesia].

作者信息

Stieglitz P, Girardet P

出版信息

Can Anaesth Soc J. 1978 May;25(3):191-7. doi: 10.1007/BF03004878.

Abstract

Physicians must choose the anaesthetics for their patients and select the methods to cheek their haemodynamic status. Experimental works do not always bring sufficient information to help them in their daily practice. Circulatory reaction to a pharmacodynamic agent is diffuse and non-specific. Some examples drawn from theoretical considerations and practical situations support this view. The difficulty of assessing the actual damage caused by one apparent variation still remains. On the other hand, haemodynamic indices such as PA, CVP, dP/dt are composed of elementary data that are interdependent; so indices are interdependent, too. A puzzling fact is that depressing anaesthetics can initiate severe haemodynamic crisis, generally badly tolerated by tissues, but better tolerated by myocardium which is not definietely altered if the anoxia inflicted is accompanied by a real decrease in cardiac work. This explains the often slight effect of short anesthetic overdosage. Previous haemodynamic variations to be countered relative to anaesthesia are not really known. Biochemistry of the venous coronary blood does not yet bring striking features in this field.

摘要

医生必须为患者选择麻醉剂,并选择检查其血流动力学状态的方法。实验研究并不总能提供足够的信息来帮助他们进行日常实践。对一种药效学药物的循环反应是弥散性的且非特异性的。从理论考量和实际情况中选取的一些例子支持了这一观点。评估一种明显变化所造成的实际损害仍然存在困难。另一方面,诸如肺动脉压(PA)、中心静脉压(CVP)、dp/dt等血流动力学指标是由相互依存的基本数据组成的;所以这些指标也是相互依存的。一个令人困惑的事实是,抑制性麻醉剂可引发严重的血流动力学危机,组织通常对此耐受性较差,但心肌耐受性较好,如果所造成的缺氧伴随着心脏做功的实际减少,心肌并不会发生明确改变。这就解释了短期麻醉用药过量往往影响轻微的原因。相对于麻醉而言,之前需要应对的血流动力学变化实际上并不清楚。静脉冠状动脉血液的生物化学在这一领域尚未呈现出显著特征。

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