Reiz S, Nath S, Rais O
Acta Anaesthesiol Scand. 1980;24(1):11-6. doi: 10.1111/j.1399-6576.1980.tb01496.x.
A thoracic epidural block from T1 to T12 was performed with plain prilocaine in four patients with coronary artery disease who were scheduled for abdominal aortic aneurysm surgery. The hemodynamic effects of the block consisted of marked reduction in arterial blood pressure due to impairment of cardiac performance and reduction in systemic vascular resistance. The heart rate decreased moderatetly. The epidural block induced a marked reduction in coronary vascular resistance with only a moderate decrease in coronary sinus blood flow. The myocardial oxygen and lactate utilization decreased in parallel to the decrease in cardiac work. In spite of the absence of arrhythmias and ST-T-segment changes following the epidural block, regional myocardial dysoxia could not be ruled out with the present methods. Administration of the cardioselective beta 1-adrenoreceptor agonist prenalterol increased cardiac performance and thereby arterial blood pressure, but did not affect the systemic or coronary vascular resistance.
对4例计划行腹主动脉瘤手术的冠心病患者，用单纯丙胺卡因实施了T1至T12节段的胸段硬膜外阻滞。该阻滞的血流动力学效应包括，因心脏功能受损导致动脉血压显著降低，以及全身血管阻力降低。心率适度下降。硬膜外阻滞使冠状动脉血管阻力显著降低，而冠状窦血流量仅适度减少。心肌氧和乳酸利用量随心脏做功的减少而平行下降。尽管硬膜外阻滞后未出现心律失常和ST-T段改变，但用目前的方法不能排除局部心肌缺氧。给予心脏选择性β1-肾上腺素能受体激动剂普瑞特罗可增强心脏功能，从而升高动脉血压，但不影响全身或冠状动脉血管阻力。
