Sharrock N E, Bading B, Mineo R, Blumenfeld J D
Department of Anesthesiology, Hospital for Special Surgery, New York, NY 10021.
Anesth Analg. 1994 Nov;79(5):899-904. doi: 10.1213/00000539-199411000-00014.
The use of hypotensive anesthesia is contraindicated in patients with ventricular dysfunction, even though afterload reduction often improves ventricular performance. The purpose of this study was to prospectively assess systemic hemodynamic responses to deliberate hypotension with epidural anesthesia in patients with chronic left ventricular dysfunction. Hemodynamic measurements were performed in 29 patients undergoing total hip arthroplasty under deliberate hypotensive epidural anesthesia using low-dose intravenous epinephrine infusion to maintain mean arterial pressure (MAP) at 50-60 mm Hg. Intraoperative MAP decreased from 100 +/- 16 to 56 +/- 9 mm Hg by 30 min after epidural injection (P < 0.0005). Concurrently, cardiac index (CI) increased from a preanesthetic baseline value of 2.9 +/- 0.5 to 3.3 +/- 0.9 L.min-1.m-2 at 30 min (P < 0.005) after epidural injection and stroke volume index (SVI) increased from 41 +/- 8 to 50 +/- 14 mL.beat-1.m-2 30 min after epidural injection (P < 0.005). Heart rate and central venous and pulmonary artery diastolic pressures were maintained under hypotension with epidural anesthesia in all patients. During deliberate hypotension with epidural anesthesia, patients with a history of congestive heart failure or low preanesthetic CI (< or = 2.5 L.kg-1.m-2) increased their CI and SVI into the normal range. There were no significant perioperative complications in either of these groups. Hypotensive epidural anesthesia can be used successfully in patients with low cardiac output from ventricular dysfunction undergoing total hip arthroplasty.
尽管降低后负荷通常可改善心室功能，但心室功能不全患者禁忌使用降压麻醉。本研究的目的是前瞻性评估慢性左心室功能不全患者在硬膜外麻醉下实施控制性低血压时的全身血流动力学反应。对29例接受全髋关节置换术的患者在硬膜外控制性低血压麻醉期间进行血流动力学测量，通过静脉输注小剂量肾上腺素将平均动脉压（MAP）维持在50 - 60 mmHg。硬膜外注射后30分钟，术中MAP从100±16 mmHg降至56±9 mmHg（P < 0.0005）。同时，硬膜外注射后30分钟心脏指数（CI）从麻醉前基线值2.9±0.5 L·min⁻¹·m⁻²增至3.3±0.9 L·min⁻¹·m⁻²（P < 0.005），每搏量指数（SVI）从41±8 mL·beat⁻¹·m⁻²增至50±14 mL·beat⁻¹·m⁻²（P < 0.005）。所有患者在硬膜外麻醉低血压期间心率、中心静脉压和肺动脉舒张压均保持稳定。在硬膜外麻醉控制性低血压期间，有充血性心力衰竭病史或麻醉前CI较低（≤2.5 L·kg⁻¹·m⁻²）的患者其CI和SVI增加至正常范围。这两组患者围手术期均无明显并发症。硬膜外低血压麻醉可成功用于因心室功能不全导致心输出量低且接受全髋关节置换术的患者。
