Fullerton D A, Jones S D, Grover F L, McIntyre R C
Department of Surgery, University of Colorado Health Sciences Center, Denver 80262, USA.
Ann Thorac Surg. 1996 Apr;61(4):1118-23; discussion 1123-4. doi: 10.1016/0003-4975(95)01149-8.
Pulmonary hypertension secondary to increased pulmonary vascular resistance may greatly complicate the perioperative management of patients having cardiac operations. Adenosine may have a therapeutic role as a selective pulmonary vasodilator. The purpose of this study was to examine the pulmonary hemodynamic effects of a central venous infusion of adenosine in cardiac operative patients with pulmonary hypertension.
Ten cardiac patients with pulmonary hypertension (age, 62 +/- 6 years) were studied in the operating room under general anesthesia after weaning from cardiopulmonary bypass. Cardiac output, pulmonary vascular resistance, systemic vascular resistance, mean pulmonary arterial pressure, and mean systemic arterial pressure were determined before, during, and after central venous infusion of adenosine (50 micrograms x kg-1 x min -1) for 15 minutes. Statistical analysis was by analysis of variance, and significance was accepted at p < 0.05.
Adenosine produced significant pulmonary vasodilation. Mean pulmonary arterial pressure was lowered from 36 +/- 1 to 28 +/- 2 mm Hg (p < 0.05), and pulmonary vascular resistance was lowered from 560 +/- 30 to 260 +/- 30 dynes x s x cm-5 (p < 0.05) during adenosine administration. At the same time, cardiac output rose from 4.0 +/- 0.6 to 6.2 L/min (p < 0.05). Pulmonary vascular resistance, mean pulmonary arterial pressure, and cardiac output returned to baseline after the adenosine infusion was stopped. There was no change in systemic mean arterial pressure during adenosine infusion.
Adenosine may be used clinically as a selective pulmonary vasodilating agent to optimize pulmonary hemodynamic indices without adverse systemic hemodynamic effects in patients with pulmonary hypertension having cardiac operations. It may be particularly valuable in patients with right heart dysfunction by selectively lowering right ventricular afterload.
继发于肺血管阻力增加的肺动脉高压会极大地使心脏手术患者的围手术期管理复杂化。腺苷作为一种选择性肺血管扩张剂可能具有治疗作用。本研究的目的是探讨在患有肺动脉高压的心脏手术患者中经中心静脉输注腺苷对肺血流动力学的影响。
10例患有肺动脉高压的心脏患者（年龄62±6岁）在心肺转流术后脱机，于全身麻醉下在手术室进行研究。在经中心静脉输注腺苷（50微克·千克⁻¹·分钟⁻¹）15分钟之前、期间和之后，测定心输出量、肺血管阻力、体循环血管阻力、平均肺动脉压和平均体循环动脉压。采用方差分析进行统计分析，p<0.05时认为具有显著性。
腺苷产生了显著的肺血管扩张作用。在输注腺苷期间，平均肺动脉压从36±1毫米汞柱降至28±2毫米汞柱（p<0.05），肺血管阻力从560±30达因·秒·厘米⁻⁵降至260±30达因·秒·厘米⁻⁵（p<0.05）。同时，心输出量从4.0±0.6升/分钟升至6.2升/分钟（p<0.05）。停止腺苷输注后，肺血管阻力、平均肺动脉压和心输出量恢复至基线水平。在腺苷输注期间，体循环平均动脉压无变化。
腺苷可在临床上用作选择性肺血管扩张剂，以优化肺血流动力学指标，而对患有肺动脉高压的心脏手术患者无不良的体循环血流动力学影响。通过选择性降低右心室后负荷，它对右心功能不全的患者可能特别有价值。
