Barneschi M G, Rossi R, Pieraccioli E, Girardi G, Novelli G P
Istituto di Anestesiologia e Rianimazione, Università degli studi di Firenze.
Minerva Anestesiol. 1994 May;60(5):245-52.
Abdominal aortic surgery has significant effects on cardiac and splanchnic perfusion. The purpose of this study was to examine the effects of dopexamine, an inodilator drug, on hemodynamic and splanchnic perfusion with measurement of gastric intramucosal pH, by the method of gastric tonometry, during abdominal aneurysm resection. Twenty-five patients undergoing excision of an aortic abdominal aneurysm were randomly divided into two groups. During aortic cross-clamping Group II patients received dopexamine infusion, at a dose of 1 microgram/kg/m, and at a dose of 0.5 micrograms/kg/m from declamping to the end of the surgery. Whereas Group I patients did not receive a dopexamine infusion. During aortic cross-clamping the intramucosal pH value decreased in Group I patients, but did not change in Group II patients. Heart rate, cardiac index, and mixed venous oxygen saturation increased significantly during dopexamine infusion, whereas systemic vascular resistance was reduced. During aortic cross-clamping dopexamine was a useful agent in improving splanchnic blood flow, cardiac index venous saturation. Also, since the drug produces dose related hemodynamic changes of rapid onset and reversibility, it is possible to interrupt the infusion before aortic declamping to avoid the decrease in the intramucosal pH value.
腹主动脉手术对心脏和内脏灌注有显著影响。本研究的目的是通过胃张力测定法，在腹主动脉瘤切除术中测量胃黏膜内pH值，研究血管扩张剂多培沙明对血流动力学和内脏灌注的影响。25例行腹主动脉瘤切除术的患者被随机分为两组。在主动脉阻断期间，第二组患者输注多培沙明，剂量为1微克/千克/分钟，从松开阻断钳到手术结束时剂量为0.5微克/千克/分钟。而第一组患者未输注多培沙明。在主动脉阻断期间，第一组患者的黏膜内pH值下降，而第二组患者的该值未改变。在输注多培沙明期间，心率、心脏指数和混合静脉血氧饱和度显著增加，而全身血管阻力降低。在主动脉阻断期间，多培沙明是改善内脏血流、心脏指数和静脉血氧饱和度的有效药物。此外，由于该药物产生与剂量相关的血流动力学变化，起效迅速且具有可逆性，因此可以在松开主动脉阻断钳之前中断输注，以避免黏膜内pH值下降。
