Hertel V G, Olthoff D, Vetter B, Giessner O, Lange S
Klinik für Anästhesiologie und Intensivtherapie, Universität Leipzig.
Anaesthesiol Reanim. 1995;20(5):116-25.
Three different methods of anaesthesia (propofol or isoflurane with fentanyl/alfentanil, atracurium and O2/air or neurolept-anaesthesia with fentanyl, dehydrobenzperidol, pancuronium and N2O/O2) were compared in 64 patients undergoing cardiac surgery before the start of extracorporeal circulation. Plasma catecholamine contents were determined and haemodynamic changes were recorded for the detection and quantification of sympathoadrenal responses to the typical points of stimulation (intubation, skin incision, sternotomy). The level of anaesthesia was held comparable by EEG monitoring (spectral edge frequencies between 8 and 12 Hz). Noradrenaline and adrenaline showed significantly lower values in the propofol group in comparison to the groups with isoflurane and neuroleptanaesthesia. The clearest increases in catecholamines were found in all groups before starting the extracorporeal circulation. There is no evident congruity between catecholamine levels and haemodynamic changes because of various interindividual differences. Derived values of haemodynamic parameters (integrals of blood pressure, rate pressure product and triple index) are more useful than single measurements for the description of circulatory reactions.
在64例体外循环开始前接受心脏手术的患者中，比较了三种不同的麻醉方法（丙泊酚或异氟烷联合芬太尼/阿芬太尼、阿曲库铵及氧气/空气，或神经安定麻醉联合芬太尼、氟哌利多、泮库溴铵及氧化亚氮/氧气）。测定血浆儿茶酚胺含量，并记录血流动力学变化，以检测和量化对典型刺激点（气管插管、皮肤切口、胸骨切开）的交感肾上腺反应。通过脑电图监测（频谱边缘频率在8至12赫兹之间）使麻醉水平保持相当。与异氟烷和神经安定麻醉组相比，丙泊酚组的去甲肾上腺素和肾上腺素值显著更低。在开始体外循环前，所有组的儿茶酚胺均出现最明显的升高。由于个体差异，儿茶酚胺水平与血流动力学变化之间没有明显的一致性。血流动力学参数的派生值（血压积分、心率血压乘积和三重指数）比单次测量更有助于描述循环反应。
