Horigome H, Tsuji M, Yamashita M, Hirano T
Department of Pediatrics, Ibaraki Children's Hospital, Mito, Japan.
Acta Paediatr Jpn. 1993 Dec;35(6):513-7. doi: 10.1111/j.1442-200x.1993.tb03100.x.
The aims of this study were to define the antagonistic effects of atropine sulfate to halothane-induced cardiovascular depression in children, and to clarify whether or not a larger dose of atropine is more effective in attenuating the cardiovascular depression. Thirty-four children aged 1-12 years who had undergone minor surgery, free from cardiac or pulmonary disease, were assigned at random to two groups. M-mode echocardiographic evaluation of left ventricular function in each patient was performed at three points (before induction, point A; after induction, point B; and following administration of atropine, point C). Results were compared between points A and B, B and C and C and A, and between the two study groups with different doses of atropine (0.01 mg/kg vs 0.02 mg/kg). Heart rate (HR), mean blood pressure (MBP) and left ventricular shortening fraction (LVSF) decreased, and left ventricular end-diastolic dimension (LVEDD) were increased significantly by halothane induction. Although HR and MBP recovered following atropine, LVSF and LVEDD remained unchanged. There were no differences found between the values after vagolysis in both study groups, except for HR and mean velocity of circumferential fiber shortening (mVcf). Heart rate increased above that of pre-induction, even following the smaller dose of atropine. The myocardial depression cannot be necessarily attenuated by vagolysis regardless of the dosage of atropine. The smaller dose (i.e. 0.01 mg/kg) seems to be sufficient only to antagonize the bradycardia and hypotension during halothane anesthesia in children.
本研究的目的是确定硫酸阿托品对氟烷诱导的儿童心血管抑制的拮抗作用，并阐明较大剂量的阿托品在减轻心血管抑制方面是否更有效。34名年龄在1至12岁之间、接受过小手术且无心脏或肺部疾病的儿童被随机分为两组。在三个时间点（诱导前，A点；诱导后，B点；给予阿托品后，C点）对每位患者进行M型超声心动图评估左心室功能。比较A点和B点、B点和C点、C点和A点之间的结果，以及两个使用不同剂量阿托品（0.01mg/kg与0.02mg/kg）的研究组之间的结果。氟烷诱导后心率（HR）、平均血压（MBP）和左心室缩短分数（LVSF）下降，左心室舒张末期内径（LVEDD）显著增加。虽然阿托品给药后HR和MBP恢复，但LVSF和LVEDD保持不变。除HR和圆周纤维缩短平均速度（mVcf）外，两个研究组迷走神经阻断后的数值之间未发现差异。即使给予较小剂量的阿托品，心率也会升至诱导前水平之上。无论阿托品剂量如何，迷走神经阻断不一定能减轻心肌抑制。较小剂量（即0.01mg/kg）似乎仅足以拮抗儿童氟烷麻醉期间的心动过缓和低血压。
