Wilkinson P L, Hamilton W K, Moyers J R, Graham B G, Ports T A, Ullyot D J, Chatterjee K
J Thorac Cardiovasc Surg. 1981 Sep;82(3):372-82.
To examine whether the hemodynamic responses to halothane or morphine-nitrous oxide anesthesia produce different patterns of myocardial ischemia in patients undergoing myocardial revascularization, we studied 26 patients anesthetized with nitrous oxide (50%) and either halothane (0.2% to 1.0% end-tidal concentration) or morphine (2 mg/kg, given intravenously). We measured systemic and coronary hemodynamics and took blood samples to measure blood gases, oxygen content, and lactate and norepinephrine concentrations. Systemic blood pressure, rate-pressure produce, systemic vascular resistance, cardiac output, and stroke work were elevated following sternotomy in patients anesthetized with morphine, whereas halothane obtunded these hemodynamic responses to surgical stress. Intraoperative myocardial ischemia occurred in both patient groups. Ten of 14 patients receiving halothane and eight of 12 receiving morphine had at least one episode of either ST-segment depression or myocardial lactate production. The difference between these groups was not statistically significant. Only patients anesthetized with morphine had a significantly elevated rate-pressure product when ischemia occurred. In this selected series of patients subjected to myocardial revascularization, two sustained a myocardial infarction and four died in the postoperative period. The incidence of these and other indices of postoperative morbidity was not related to choice of primary anesthetic and did not differ between the patients who sustained ischemia and those who did not.
为了研究在接受心肌血运重建术的患者中，氟烷或吗啡 - 氧化亚氮麻醉引起的血流动力学反应是否会导致不同类型的心肌缺血，我们对26例接受氧化亚氮（50%）麻醉且使用氟烷（呼气末浓度0.2%至1.0%）或吗啡（2mg/kg，静脉注射）的患者进行了研究。我们测量了全身和冠状动脉的血流动力学指标，并采集血样以测定血气、氧含量、乳酸和去甲肾上腺素浓度。在接受吗啡麻醉的患者中，开胸术后全身血压、心率 - 血压乘积、全身血管阻力、心输出量和每搏功均升高，而氟烷减弱了这些对手术应激的血流动力学反应。两组患者术中均发生了心肌缺血。接受氟烷麻醉的14例患者中有10例、接受吗啡麻醉的12例患者中有8例至少出现一次ST段压低或心肌乳酸生成。两组之间的差异无统计学意义。仅接受吗啡麻醉的患者在发生缺血时心率 - 血压乘积显著升高。在这组接受心肌血运重建术的特定患者系列中，有2例发生心肌梗死，4例在术后死亡。这些以及其他术后发病率指标的发生率与初始麻醉药物的选择无关，且在发生缺血的患者和未发生缺血的患者之间无差异。
