Van Hemelrijck J, Waets P, Van Aken H, Lacroix H, Nevelsteen A, Suy R
Department of Anesthesiology, Universitaire Ziekenhuizen K.U.L., Katholieke Universiteit Leuven, Belgium.
J Cardiothorac Vasc Anesth. 1993 Jun;7(3):273-8. doi: 10.1016/1053-0770(93)90004-5.
The efficacy and hemodynamic effects of urapidil, an arteriolar vasodilator, and isosorbide dinitrate, a venodilator, were compared, when used for blood pressure control during abdominal aortic surgery. Urapidil is an alpha-adrenergic receptor antagonist with serotonin-1A receptor-agonist activity in the central nervous system. Hemodynamic profiles were recorded before and after the administration of the study drug (+/- 10 minutes before aortic clamping), 3 and 10 minutes following aortic clamping, and before and 3 and 10 minutes following the removal of the aortic clamp. Arterial and mixed venous oxygen contents were compared. Both groups of 18 patients were similar with respect to demographic profiles, anesthetic technique, and perioperative fluid therapy. Identical heart rate and blood pressure profiles were obtained. In contrast to isosorbide dinitrate, urapidil produced a 17% (P < 0.05) increase in cardiac index as a result of a 30% (P < 0.001) decrease in systemic vascular resistance before placement of the aortic clamp. In patients treated with urapidil, cardiac index was higher (P < 0.05) 10 minutes after aortic clamping, before removal of the clamp, and 10 minutes later. The arterio-venous oxygen content difference decreased from 3.2 +/- 0.8 mL O2/dL to 2.4 +/- 1.0 mL O2/dL (P < 0.01) following urapidil, but did not change during the administration of isosorbide dinitrate. It is concluded that urapidil is an effective and safe drug for the prevention of the hemodynamic consequences of aortic clamping. Compared to a venodilator (isosorbide dinitrate), urapidil offers the advantage of improving cardiac output and oxygen delivery.
比较了小动脉血管扩张剂乌拉地尔和静脉血管扩张剂硝酸异山梨酯在腹主动脉手术中用于控制血压时的疗效和血流动力学效应。乌拉地尔是一种α-肾上腺素能受体拮抗剂，在中枢神经系统具有5-羟色胺-1A受体激动剂活性。在给予研究药物前（主动脉钳夹前±10分钟）、主动脉钳夹后3分钟和10分钟以及主动脉钳夹移除前、移除后3分钟和10分钟记录血流动力学参数。比较动脉血和混合静脉血的氧含量。两组各18例患者在人口统计学特征、麻醉技术和围手术期液体治疗方面相似。获得了相同的心率和血压曲线。与硝酸异山梨酯不同，在放置主动脉钳夹前，乌拉地尔使全身血管阻力降低30%（P<0.001），从而使心脏指数增加17%（P<0.05）。在接受乌拉地尔治疗的患者中，主动脉钳夹后10分钟、移除钳夹前以及移除后10分钟时心脏指数较高（P<0.05）。乌拉地尔治疗后动静脉氧含量差从3.2±0.8 mL O2/dL降至2.4±1.0 mL O2/dL（P<0.01），而在给予硝酸异山梨酯期间未发生变化。结论是乌拉地尔是预防主动脉钳夹血流动力学后果的有效且安全的药物。与静脉血管扩张剂（硝酸异山梨酯）相比，乌拉地尔具有改善心输出量和氧输送的优势。
