Moreno N N, de Campo T, Kaiser G A, Pallares V S
J Thorac Cardiovasc Surg. 1980 Aug;80(2):182-6.
Neurologic and abdominal complications can occur in the postoperative period of aortic coarctation repair, ischemia being the pathogenic factor most likely to be involved. This study was designed to evaluate the extent of the hemodynamic changes proximal and distal to the coarctation at the time of cross-clamping, as well as the effects of pentolinium and isoproterenol upon the hemodynamic changes. Included in the study were 17 patients with adult type coarctations who had dual hemodynamic monitoring. During cross-clamping, there was an increase in the gradient between proximal and distal pressures, with severe distal hypotension (< 50 mm Hg) occurring in six patients. Isoproterenol corrected the hypotension in five patients, but the sixth required a surgical shunt. Pentolinium was effective for the treatment of proximal hypertension; however, it also decreased distal pressure. The ligation of collateral vessels was associated with a decrease in distal pressures as well. During cross-clamping, pentolinium was useful for the management of proximal hypertension and isoproterenol increased the distal pressures in some of the patients who presented distal hypotension. However, because of the difficulties in predicting the individual response, their administration would be best guided by dual pressure monitoring. It is postulated that the recognition and proper treatment of distal hypotension may be an important factor in the prophylaxis of postoperative complications.
主动脉缩窄修复术后可出现神经和腹部并发症，缺血是最可能涉及的致病因素。本研究旨在评估阻断主动脉时缩窄近端和远端血流动力学变化的程度，以及潘托铵和异丙肾上腺素对血流动力学变化的影响。该研究纳入了17例接受双血流动力学监测的成人型主动脉缩窄患者。在阻断主动脉期间，近端和远端压力之间的梯度增加，6例患者出现严重的远端低血压（<50 mmHg）。异丙肾上腺素纠正了5例患者的低血压，但第6例患者需要进行手术分流。潘托铵对治疗近端高血压有效；然而，它也降低了远端压力。结扎侧支血管也与远端压力降低有关。在阻断主动脉期间，潘托铵有助于处理近端高血压，异丙肾上腺素可提高一些出现远端低血压患者的远端压力。然而，由于难以预测个体反应，其应用最好在双压力监测的指导下进行。据推测，识别并妥善处理远端低血压可能是预防术后并发症的一个重要因素。
