Goertz A W, Seeling W, Heinrich H, Lindner K H, Rockemann M G, Georgieff M
Department of Anesthesiology, University of Ulm Medical Center, Federal Republic of Germany.
Anesth Analg. 1993 Mar;76(3):541-5. doi: 10.1213/00000539-199303000-00015.
The effect of phenylephrine (PHE) boluses on left ventricular (LV) function was examined in patients without cardiovascular disease who developed arterial hypotension during high thoracic epidural anesthesia (TEA) combined with general anesthesia (GA) (group 1) or lumbar epidural anesthesia (LEA) combined with GA (group 2). LV function was assessed by transesophageal echocardiography (TEE) before and after central venous injection of 1 microgram/kg PHE. Fractional diameter shortening (FDS), end-systolic wall stress (ESWS), and rate-corrected velocity of circumferential fiber shortening (mVcfc) were determined. PHE effectively restored arterial blood pressure in both groups with a peak effect between 30 and 45 s after injection. FDS was reduced from 38% to 25% (mean, P < 0.01) in group 1 and remained unchanged in group 2. ESWS increased from 70 to 143 x 10(3) dyne.cm-2 (P < 0.01) and from 57 to 86 x 10(3) dyne.cm-2 (P < 0.05), in groups 1 and 2, respectively. mVcfc was significantly reduced from 1.11 to 0.80 circ/s (P < 0.05) in group 1 and was not altered in group 2. The authors conclude that PHE given as an intravenous bolus to patients under high TEA plus general anesthesia causes a transient impairment of LV function.
在接受高胸段硬膜外麻醉（TEA）联合全身麻醉（GA）（第1组）或腰段硬膜外麻醉（LEA）联合GA（第2组）期间发生动脉低血压的无心血管疾病患者中，研究了去氧肾上腺素（PHE）推注对左心室（LV）功能的影响。在中心静脉注射1微克/千克PHE之前和之后，通过经食管超声心动图（TEE）评估LV功能。测定缩短分数直径（FDS）、收缩末期壁应力（ESWS）和圆周纤维缩短率校正速度（mVcfc）。PHE有效恢复了两组的动脉血压，注射后30至45秒达到峰值效应。第1组的FDS从38%降至25%（平均值，P<0.01），第2组保持不变。第1组和第2组的ESWS分别从70增加到143×10（3）达因·厘米-2（P<0.01）和从57增加到86×10（3）达因·厘米-2（P<0.05）。第1组的mVcfc从1.11显著降至0.80周/秒（P<0.05），第2组未改变。作者得出结论，在高TEA加全身麻醉下给患者静脉推注PHE会导致LV功能短暂受损。
