Zerkowski H R, Günnicker M, Marggraf G, Reidemeister J C
Abteilung für Thorax- und Kardiovaskuläre Chirurgie, Universitätsklinikum Essen.
Z Kardiol. 1994;83 Suppl 2:55-61.
Perioperative deterioration of the circulatory performance of patients undergoing heart surgery ranges from transitory impairment in cardiac output by deterioration of the compensation range of the oxygen transport system to manifest circulatory failure without previous myocardial damage and the acute decompensation of pre-existing chronic heart failure. On the basis of the current state of knowledge in this field, a concept for rational staged treatment should be based on the different myocardial beta-adrenoceptor conditions related to the type and stage of the individual underlying heart disease and on adrenoceptor subtype specific properties of positive inotropic drugs. 1. The therapy of perioperative "circulatory" insufficiency after extra-corporal circulation consists of the use of drugs to adapt the performance of the oxygen transport system to increased overall oxygen demand. Simultaneous volume loading (by CVP) and positive inotropic support with dobutamine are the best means of treating this (normally transitory) dysregulation. 2. In the case of manifest severe circulatory insufficiency (low cardiac output syndrome), sepsis or acute heart failure (e.g., following acute myocardial infarction), the use of a pulmonary artery catheter for determining perioperative cardiac output and resistance is essential. In such cases, positive inotropic therapy is based on catecholamines of medium (dobutamine) to high (adrenaline) efficacy, because it can be assumed that the beta-adrenoceptor pattern will remain normal with regular functioning and regulation of the (remaining) myocardium up to the onset of acute heart failure.(ABSTRACT TRUNCATED AT 250 WORDS)
接受心脏手术患者围手术期循环功能恶化的情况各异，从氧运输系统代偿范围恶化导致的心输出量短暂受损，到无既往心肌损伤的明显循环衰竭，以及既往慢性心力衰竭的急性失代偿。基于该领域目前的知识状况，合理的分期治疗概念应基于与个体潜在心脏病类型和阶段相关的不同心肌β-肾上腺素能受体状况，以及正性肌力药物的肾上腺素能受体亚型特异性特性。1. 体外循环后围手术期“循环”功能不全的治疗包括使用药物使氧运输系统的功能适应总体氧需求的增加。同时进行容量负荷（通过中心静脉压）和用多巴酚丁胺进行正性肌力支持是治疗这种（通常为短暂性）调节异常的最佳方法。2. 在明显严重循环功能不全（低心输出量综合征）、脓毒症或急性心力衰竭（如急性心肌梗死后）的情况下，使用肺动脉导管测定围手术期心输出量和阻力至关重要。在这种情况下，正性肌力治疗基于中效（多巴酚丁胺）至高（肾上腺素）效能的儿茶酚胺，因为可以假定在（剩余）心肌正常运作和调节直至急性心力衰竭发作之前，β-肾上腺素能受体模式将保持正常。（摘要截选至250字）
