Fullerton D A, St Cyr J A, Albert J D, Grover F L
Department of Surgery, University of Colorado Health Sciences Center, Denver 80262.
Ann Thorac Surg. 1993 Dec;56(6):1263-6. doi: 10.1016/0003-4975(93)90663-3.
Cardiac surgical patients frequently require catecholamines, typically administered via the central venous circulation. Potential disadvantages of this route of administration include catecholamine metabolism by the pulmonary vascular bed before gaining access to the heart and pulmonary vasoconstriction producing increased pulmonary vascular resistance. We therefore prospectively compared administration of epinephrine via the left atrium versus central venous administration of epinephrine with particular interest in cardiac output, mean pulmonary artery pressure, and pulmonary vascular resistance. Fifteen consecutive aortocoronary bypass patients were studied after cardiopulmonary bypass. Epinephrine (mean dose, 0.07 +/- 0.02 micrograms.kg-1.min-1) was administered via the central venous route, then via the left atrium, then via the central venous route again. Hemodynamic data were collected 10 minutes after changing the route of administration. Left atrial administration of epinephrine produced a 35% greater cardiac output, 25% lower pulmonary artery pressure, and 32% lower pulmonary vascular resistance when compared with central venous administration (all significant; p < 0.05). Left atrial epinephrine administration may offer hemodynamic advantage in cardiac surgical patients in whom central venous administration does not produce an adequate cardiac output or in patients with pulmonary hypertension to avoid any further increase in pulmonary vascular resistance.
心脏外科手术患者经常需要使用儿茶酚胺类药物，通常通过中心静脉循环给药。这种给药途径的潜在缺点包括儿茶酚胺在进入心脏之前被肺血管床代谢，以及肺血管收缩导致肺血管阻力增加。因此，我们前瞻性地比较了经左心房给予肾上腺素与经中心静脉给予肾上腺素的情况，特别关注心输出量、平均肺动脉压和肺血管阻力。对15例连续的主动脉冠状动脉搭桥手术患者在体外循环后进行了研究。肾上腺素（平均剂量，0.07±0.02微克·千克⁻¹·分钟⁻¹）先经中心静脉途径给药，然后经左心房给药，之后再经中心静脉途径给药。在改变给药途径10分钟后收集血流动力学数据。与经中心静脉给药相比，经左心房给予肾上腺素时心输出量增加35%，肺动脉压降低25%，肺血管阻力降低32%（均有显著差异；p<0.05）。对于中心静脉给药不能产生足够心输出量的心脏外科手术患者或患有肺动脉高压以避免肺血管阻力进一步增加的患者，经左心房给予肾上腺素可能具有血流动力学优势。
