Hoeft A, Sonntag H, Stephan H, Kettler D
Department of Anesthesiology, Emergency, and Intensive Care Medicine, University of Göttingen, Germany.
Anesth Analg. 1994 May;78(5):857-66. doi: 10.1213/00000539-199405000-00006.
A maximum efficiency of myocardial oxygen utilization is desirable, especially in patients with limited coronary blood supply. Little is known about the effects of anesthesia on the efficiency of myocardial oxygen utilization. The aim of this retrospective study was to investigate the effects of different types of anesthesia on myocardial efficiency in patients undergoing coronary bypass surgery. Myocardial blood flow (Argon wash in technique), myocardial oxygen uptake, and standard hemodynamics were measured awake, after induction of anesthesia, and during sternal spread. Myocardial oxygen utilization efficiency was calculated from the ratio of external work divided by myocardial oxygen consumption. Sixty-five patients in eight groups with different anesthetic techniques were studied: 1) halothane/nitrous oxide, 2) enflurane/nitrous oxide, 3) high-dose morphine, 4) high-dose fentanyl, 5) fentanyl/midazolam, 6) high-dose sufentanil, 7) sufentanil/nitrous oxide, and 8) propofol. In all groups induction of anesthesia was associated with a decrease of cardiac work (from 86 +/- 17 to 55 +/- 16 J/min in pooled data) which resulted from a decrease of both stroke volume index and blood pressure. However, myocardial oxygen consumption did not decrease proportionally (from 11.2 +/- 3.0 to 8.5 +/- 2.3 mL.min-1 x 100 g-1 in pooled data) and myocardial oxygen utilization efficiency was therefore decreased in all groups (from 29.2% +/- 2.5% at awake state to 23.9% +/- 5.8% after induction of anesthesia in pooled data). Surgical stimulation by sternotomy and sternal spread was associated with different patterns of hemodynamic response between groups. Blood pressures and external work tended to be higher in the high-dose narcotic groups while it remained less affected in the other groups. However, myocardial efficiency remained depressed in all groups (22.2% +/- 8.2% in pooled data) and with respect to myocardial efficiency no differences between anesthetic techniques were found. We conclude that the specific anesthetic technique does not influence impairment of myocardial oxygen utilization efficiency by anesthesia.
理想的情况是心肌氧利用率达到最高，尤其是在冠状动脉供血受限的患者中。关于麻醉对心肌氧利用率的影响，目前了解甚少。这项回顾性研究的目的是调查不同类型麻醉对接受冠状动脉搭桥手术患者心肌效率的影响。在清醒状态、麻醉诱导后以及胸骨撑开期间，测量心肌血流量（氩气冲洗技术）、心肌氧摄取量和标准血流动力学指标。心肌氧利用效率通过外部功除以心肌氧消耗量的比值来计算。对采用不同麻醉技术的八组65例患者进行了研究：1）氟烷/氧化亚氮；2）恩氟烷/氧化亚氮；3）大剂量吗啡；4）大剂量芬太尼；5）芬太尼/咪达唑仑；6）大剂量舒芬太尼；7）舒芬太尼/氧化亚氮；8）丙泊酚。在所有组中，麻醉诱导均与心脏功降低相关（汇总数据中从86±17降至55±16 J/min），这是由于每搏量指数和血压均下降所致。然而，心肌氧消耗量并未成比例下降（汇总数据中从11.2±3.0降至8.5±2.3 mL·min⁻¹×100 g⁻¹），因此所有组的心肌氧利用效率均降低（汇总数据中从清醒状态下的29.2%±2.5%降至麻醉诱导后的23.9%±5.8%）。胸骨切开术和胸骨撑开的手术刺激在不同组之间与血流动力学反应模式不同有关。大剂量麻醉剂组的血压和外部功往往较高，而其他组受影响较小。然而，所有组的心肌效率仍然降低（汇总数据中为22.2%±8.2%），并且在心肌效率方面未发现不同麻醉技术之间存在差异。我们得出结论，特定的麻醉技术不会影响麻醉对心肌氧利用效率的损害。
