Palmisano B W, Mehner R W, Baker J E, Stowe D F, Bosnjak Z J, Kampine J P
Department of Anesthesiology, Medical College of Wisconsin, Milwaukee 53226, USA.
Anesth Analg. 1995 Jun;80(6):1122-8. doi: 10.1097/00000539-199506000-00009.
In this study we compared the direct myocardial effects of halothane and isoflurane between chronically hypoxemic and normoxemic infant hearts with an isolated, perfused, nonworking rabbit heart model. Anesthetic effects were measured on heart rate, atrioventricular time, coronary flow, O2 consumption and extraction, and left and right ventricular peak systolic and end-diastolic pressures, nd -dP/dtmax; and tau, the time constant of isovolumic relaxation. Control values were similar between chronically hypoxemic and normoxemic groups except for variables affected by right ventricular (RV) hypertrophy in chronically hypoxemic hearts. For these variables values were significantly larger in the chronically hypoxemic group (P < or = 0.05): coronary flow (12.3 +/- 0.4 vs 10.3 +/- 0.3 mL.min-1.g-1), RV peak systolic pressure (68 +/- 3 vs 53 +/- 4 mm Hg), RV + dP/dtmax (1.42 +/- 0.07 vs 1.03 +/- 0.08 mm Hg/ms), and RV -dP/dtmax (-0.99 +/- 0.04 vs -0.78 +/- 0.08 mm Hg/ms). (Values are mean +/- SEM.) With anesthesia, values were similar between chronically hypoxemic and normoxemic groups except for coronary flow, which was significantly greater in chronically hypoxemic hearts for both anesthetics (14.1 +/- 0.9 vs 11.3 +/- 0.7 mL.min-1.g-1 for halothane and 15.4 +/- 1.1 vs 12.2 +/- 0.6 mL.min-1.g-1 for isoflurane). The degree of depression of RV peak systolic pressure and RV + dP/dtmax by both anesthetics, and of RV - dP/dtmax by isoflurane, was significantly larger in chronically hypoxemic hearts because these hearts had greater control values but similar anesthetic values to normoxemic hearts.(ABSTRACT TRUNCATED AT 250 WORDS)
在本研究中,我们使用离体、灌注、无负荷的兔心脏模型,比较了氟烷和异氟烷对慢性低氧血症和正常氧血症婴儿心脏的直接心肌效应。测量了麻醉对心率、房室时间、冠状动脉血流量、氧气消耗和摄取,以及左右心室收缩压峰值和舒张末期压力、dp/dtmax和tau(等容舒张时间常数)的影响。除了受慢性低氧血症心脏右心室(RV)肥厚影响的变量外,慢性低氧血症组和正常氧血症组的对照值相似。对于这些变量,慢性低氧血症组的值显著更大(P≤0.05):冠状动脉血流量(12.3±0.4对10.3±0.3 mL·min-1·g-1)、RV收缩压峰值(68±3对53±4 mmHg)、RV +dp/dtmax(1.42±0.07对1.03±0.08 mmHg/ms)和RV -dp/dtmax(-0.99±0.04对-0.78±0.08 mmHg/ms)。(数值为平均值±标准误)。麻醉后,慢性低氧血症组和正常氧血症组的值相似,但冠状动脉血流量除外,两种麻醉药在慢性低氧血症心脏中的冠状动脉血流量均显著更高(氟烷为14.1±0.9对11.3±0.7 mL·min-1·g-1,异氟烷为15.4±1.1对12.2±0.6 mL·min-1·g-1)。两种麻醉药对RV收缩压峰值和RV +dp/dtmax的抑制程度,以及异氟烷对RV -dp/dtmax的抑制程度,在慢性低氧血症心脏中显著更大,因为这些心脏的对照值更高,但与正常氧血症心脏的麻醉值相似。(摘要截断于250字)