Ohe Y, Satoh K, Hashimoto N, Tachibana C, Fukada T, Furuya Y
Department of Anesthesiology, Tokyo Women's Medical College Daini Hospital.
Masui. 1993 May;42(5):683-9.
We studied the circulatory and respiratory effects of methylprednisolone (MPS) associated with catecholamine administration of a few hours after cardiopulmonary bypass (CPB). Forty patients undergoing coronary artery bypass grafting were randomly divided into two groups. Twenty patients in group 1 [MPS (-) group] did not receive MPS and 20 patients in group 2 [MPS (+) group] received MPS 15 mg.kg-1 i.v. 60 minutes after CPB. The circulatory and respiratory parameters were measured 60 minutes after CPB, 30 minutes after MPS i.v. and 60 minutes after MPS i.v. The values in MPS (-) group were compared with those in MPS (+) group. CI and SVI decreased, and SVRI and PQR increased in MPS (-) group, but these values were unchanged in MPS (+) group. RAP, mPAP, PCWP and PVRI were unchanged in MPS (-) group. PCWP increased and the other values were unchanged in MPS (+) group. The blood gases and pulmonary alveolar function were not different between the two groups. The oxygen delivery decreased in MPS (-) group, but it was unchanged in MPS (+) group. The oxygen consumption was unchanged in the two groups. Blood cortisol increased and epinephrine and norepinephrine decreased in MPS (+) group. Methylprednisolone had an effect to improve the decreased CI and the increased SVRI, and no respiratory problems were observed in patients for coronary artery bypass grafting with catecholamine administration for a few hours after cardiopulmonary bypass.
我们研究了在体外循环(CPB)数小时后给予儿茶酚胺的同时使用甲泼尼龙(MPS)对循环和呼吸的影响。40例行冠状动脉旁路移植术的患者被随机分为两组。第1组20例患者[MPS(-)组]未接受MPS,第2组20例患者[MPS(+)组]在CPB后60分钟静脉注射MPS 15mg·kg-1。在CPB后60分钟、静脉注射MPS后30分钟和静脉注射MPS后60分钟测量循环和呼吸参数。将MPS(-)组的值与MPS(+)组的值进行比较。MPS(-)组的心指数(CI)和每搏量指数(SVI)下降,全身血管阻力指数(SVRI)和肺血管阻力指数(PVRl)升高,但MPS(+)组这些值未改变。MPS(-)组的右房压(RAP)、平均肺动脉压(mPAP)、肺毛细血管楔压(PCWP)和肺血管阻力指数(PVRI)未改变。MPS(+)组的PCWP升高,其他值未改变。两组的血气和肺泡功能无差异。MPS(-)组的氧输送下降,但MPS(+)组未改变。两组的氧消耗未改变。MPS(+)组血皮质醇升高,肾上腺素和去甲肾上腺素下降。甲泼尼龙对改善降低的CI和升高的SVRI有作用,在体外循环后数小时给予儿茶酚胺的冠状动脉旁路移植术患者中未观察到呼吸问题。