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[诱导性低温下腹腔热灌注期间的血流动力学变化]

[The hemodynamic changes during the intraperitoneal hyperthermic perfusion under induced hypothermia].

作者信息

Isawa E, Sumida M

机构信息

Department of Anesthesia, Social Insurance Funabashi Central Hospital, Funabashi.

出版信息

Masui. 1994 Nov;43(11):1693-700.

PMID:7861601
Abstract

We investigated the whole body oxygen consumption (VO2) and the hemodynamic changes during the intraperitoneal hyperthermic perfusion (IPHP), which was coupled with induced hypothermia to prevent the cerebral disorder. IPHP was carried out for 90-120 min with 45-47 degrees C perfusate after the operation. We induced hypothermia using the surface cooling method and the infusion of triflupromazin. In no patient, the pulmonary artery temperature (PAT) rose above 40 degrees C. In the IPHP, there was a significant correlation between VO2 and PAT. If PAT reached 42 degrees C during the IPHP, VO2 would increase to 130-140% of the value at 37-38 degrees C. This rise is smaller than that during the total body hyperthermia (TBH), in which VO2 at 42 degrees C reached 130-190% of the value at 38 degrees C. Heart rate increased in proportion to the rising rate of body temperature. During the IPHP, PAT sometimes rose remarkably about 8 degrees C (from 32 degrees C to 40 degrees C) with a marked rise in heart rate. This rising rate of PAT is greater than that of TBH, in which PAT rose about 4-5 degrees C (from 37-38 degrees C to 42 degrees C). We consider that IPHP is not applicable to the patients with ischemic heart disease. During the rise of PAT, other circulatory parameters related to IPHP, changed in the same direction as those related to TBH. The rate of change of these parameters related to IPHP was smaller than that of the TBH, because during the IPHP the highest PAT was lower than that during TBH.

摘要

我们研究了腹腔内热灌注(IPHP)期间的全身耗氧量(VO₂)和血流动力学变化,该过程结合诱导性低温以预防脑部疾病。术后使用45 - 47℃的灌注液进行90 - 120分钟的IPHP。我们使用体表降温法和氟奋乃静输注诱导低温。在所有患者中,肺动脉温度(PAT)均未升至40℃以上。在IPHP期间,VO₂与PAT之间存在显著相关性。如果在IPHP期间PAT达到42℃,VO₂将增加至37 - 38℃时数值的130 - 140%。这种升高幅度小于全身热疗(TBH)期间的升高幅度,在TBH中,42℃时的VO₂达到38℃时数值的130 - 190%。心率随体温上升速率成比例增加。在IPHP期间,PAT有时会显著上升约8℃(从32℃升至40℃),同时心率显著上升。PAT的这种上升速率大于TBH中的上升速率,在TBH中,PAT上升约4 - 5℃(从37 - 38℃升至42℃)。我们认为IPHP不适用于缺血性心脏病患者。在PAT上升期间,与IPHP相关的其他循环参数与与TBH相关的参数变化方向相同。与IPHP相关的这些参数的变化速率小于TBH中的变化速率,因为在IPHP期间最高PAT低于TBH期间的最高PAT。

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