Mora A, Cortés C, López G, Ballvé M, Cabarrocas E
Servicio de Anestesiología y Reanimación, Hospital General Universitario Vall d'Hebron, Barcelona.
Rev Esp Anestesiol Reanim. 1994 Sep-Oct;41(5):262-7.
To assess the hypotensive and antiarrhythmic effect of adenosine triphosphate (ATP) and its impact on hypertensive crises and heart rhythm abnormalities resulting from surgery to remove pheochromocytoma.
A prospective study of 7 patients with pheocromocytoma who were scheduled for unilateral (4) or bilateral (3) suprarenalectomy prior to treatment with phenoxybenzamine and propranolol. The anesthetic procedure was the same for all patients, as was monitoring: ECG, digital pulse oximetry, capnography, direct recording of arterial pressure by a catheter in the left radial artery and a Swan-Ganz fiber optic catheter in the pulmonary artery to measure pulmonary pressures and mixed venous oxygen saturation. Minute volume was measured by thermodilution. Blood glucose levels and urine excreted through a catheter were recorded hourly during surgery. During surgery, when arterial pressure had risen 20% above baseline level, i.v. infusion of ATP 0.5 mg/kg/min was begun and adjusted up or down depending on patient response. Infusion was stopped when the suprarenal vein had been tied. Hemodynamic analysis was performed during 4 phases: 1) start of surgery; 2) during manipulation of the tumor; 3) after excision, and 4) after surgery. Hemodynamic and metabolic variables were recorded, as were ATP doses and requirements for vasopressors and antiarrhythmic drugs.
We found the following changes between phase 1 and phase 2, coinciding with ATP infusion: systemic arterial pressure increased 22.2%, heart rate increased 28.04% (with no cardiac arrhythmia observed in any patient), pulmonary artery pressure rose 25.35%, pulmonary capillary pressure rose 22.17%, cardiac index rose 108% while systemic vascular resistance decreased 55.82% and pulmonary vascular resistance decreased 33.96%.(ABSTRACT TRUNCATED AT 250 WORDS)
评估三磷酸腺苷（ATP）的降压和抗心律失常作用，及其对因切除嗜铬细胞瘤手术导致的高血压危象和心律异常的影响。
一项前瞻性研究，纳入7例嗜铬细胞瘤患者，这些患者计划在接受苯氧苄胺和普萘洛尔治疗前接受单侧（4例）或双侧（3例）肾上腺切除术。所有患者的麻醉程序相同，监测也相同：心电图、数字脉搏血氧饱和度测定、二氧化碳描记法、通过左桡动脉导管直接记录动脉压以及通过肺动脉内的 Swan-Ganz 光纤导管测量肺压和混合静脉血氧饱和度。通过热稀释法测量每分通气量。手术期间每小时记录血糖水平和通过导管排出的尿液。手术期间，当动脉压比基线水平升高20%时，开始静脉输注ATP，剂量为0.5毫克/千克/分钟，并根据患者反应进行上调或下调。当肾上腺静脉结扎后停止输注。在4个阶段进行血流动力学分析：1）手术开始时；2）肿瘤操作期间；3）切除后；4）手术后。记录血流动力学和代谢变量，以及ATP剂量和血管升压药及抗心律失常药物的使用需求。
我们发现，在第1阶段和第2阶段之间，与ATP输注同时出现了以下变化：全身动脉压升高22.2%，心率升高28.04%（所有患者均未观察到心律失常），肺动脉压升高25.35%，肺毛细血管压升高22.17%，心脏指数升高108%，而全身血管阻力降低55.82%，肺血管阻力降低33.96%。（摘要截断于250字）
