Urzua J, Serra M, Lema G, Canessa R, Gonzalez R, Meneses G, Irarrazaval M, Moran S
Department of Anaesthetics, Pontificia Universidad Catolica de Chile, Santiago, Chile.
Anaesth Intensive Care. 1996 Oct;24(5):579-84. doi: 10.1177/0310057X9602400513.
The aim of the study was to compare three anaesthetic agents in patients with ejection fraction below 0.40 subjected to coronary revascularization surgery. Twenty five elective coronary surgical patients with ejection fraction below 0.40 were prospectively studied. Premedication was pethidine 1 mg/kg and induction was fentanyl 0.03 mg/kg and pancuronium 0.1 mg/kg. The patients were randomized to one of three maintenance techniques (fentanyl, isoflurane or halothane). Radial arterial pressure, heart rate, right atrial pressure, pulmonary arterial and occluded pressures, and thermodilution cardiac output were measured, and cardiac index and resistance calculated, at the following times: before induction; 5 min after intubation; 2 min after sternotomy; immediately after discontinuation of bypass; 15 min afterwards; immediately after sternal closure; during suture of the skin; 5 min after arrival in the postoperative care unit; and 60 min postoperatively. Mean arterial pressure decreased significantly in the isoflurane group and nonsignificantly in the halothane group after induction. Cardiac index decreased significantly in the isoflurane group and nonsignificantly in the halothane group after induction and after sternotomy. Neither pressure nor flow decreased in patients receiving fentanyl. Following weaning from cardiopulmonary bypass, systemic vascular resistance decreased significantly in all groups. Cardiac index, however, did not increase above control values and arterial pressure consequently decreased; there was no significant difference between groups.
本研究的目的是比较三种麻醉剂在射血分数低于0.40且接受冠状动脉血运重建手术患者中的应用情况。对25例射血分数低于0.40的择期冠状动脉手术患者进行了前瞻性研究。术前用药为哌替啶1mg/kg，诱导用药为芬太尼0.03mg/kg和潘库溴铵0.1mg/kg。患者被随机分为三种维持技术（芬太尼、异氟烷或氟烷）之一。在以下时间测量桡动脉压、心率、右心房压、肺动脉压和阻塞压以及热稀释心输出量，并计算心脏指数和阻力：诱导前；插管后5分钟；胸骨切开后2分钟；体外循环停止后立即测量；之后15分钟；胸骨关闭后立即测量；皮肤缝合时测量；到达术后护理单元后5分钟；术后60分钟。诱导后异氟烷组平均动脉压显著下降，氟烷组无显著下降。诱导后及胸骨切开后，异氟烷组心脏指数显著下降，氟烷组无显著下降。接受芬太尼的患者压力和流量均未下降。脱离体外循环后，所有组的全身血管阻力均显著下降。然而，心脏指数并未升高至对照值以上，动脉压因此下降；各组之间无显著差异。
