Kieler-Jensen N, Milocco I, Kirnö K, Houltz E, Ricksten S E
Department of Anesthesia and Intensive Care, Sahlgrenska University Hospital, Gothenburg, Sweden.
J Cardiothorac Vasc Anesth. 1996 Oct;10(6):741-7. doi: 10.1016/S1053-0770(96)80199-6.
To study the effects of incremental infusion rates of prostacyclin on myocardial blood flow and metabolism and central hemodynamics shortly after coronary artery bypass grafting.
A pharmacodynamic dose-response study.
A multi-institutional university hospital.
Twelve patients with two- or three-vessel coronary artery disease and with an ejection fraction greater than 0.5 were studied in the operating room after sternal closure and elective coronary artery bypass grafting.
Prostacyclin was administered at infusion rates of 2.5, 5, 10, and 20 ng/kg/min. Systemic and pulmonary hemodynamics and global (coronary sinus) as well as regional (great cardiac vein) myocardial blood flow and metabolic variables were measured.
Infusion rates of 10 and 20 ng/kg/min decreased mean arterial blood pressure (13% and 21%, respectively), systemic vascular resistance (31% and 42%), and pulmonary vascular resistance (11% and 33%), increased cardiac output (28% and 37%), heart rate (9% and 13%), and stroke volume (15% and 20%), but had no effect on central filling pressures. Prostacyclin caused no changes in great cardiac vein flow or coronary sinus flow. Furthermore, prostacyclin caused no changes in regional myocardial oxygen extraction, indicating that prostacyclin did not induce direct coronary vasodilation. There were no electrocardiographic or obvious metabolic signs of myocardial ischemia during prostacyclin infusion.
Prostacyclin may be a useful afterload-reducing compound after coronary artery bypass grafting because it has no direct coronary vasodilatory effect, which minimizes the risk of myocardial ischemia.
研究冠状动脉搭桥术后即刻，前列环素递增输注速率对心肌血流、代谢及中心血流动力学的影响。
一项药效学剂量反应研究。
一所多机构大学医院。
12例患有双支或三支冠状动脉疾病且射血分数大于0.5的患者，在胸骨闭合及择期冠状动脉搭桥术后于手术室接受研究。
以2.5、5、10和20 ng/kg/分钟的输注速率给予前列环素。测量全身和肺血流动力学以及整体（冠状窦）和局部（大心静脉）心肌血流及代谢变量。
10和20 ng/kg/分钟的输注速率降低了平均动脉血压（分别降低13%和21%）、全身血管阻力（分别降低31%和42%）以及肺血管阻力（分别降低11%和33%），增加了心输出量（分别增加28%和37%）、心率（分别增加9%和13%）以及每搏输出量（分别增加15%和20%），但对中心充盈压无影响。前列环素未引起大心静脉血流或冠状窦血流的变化。此外，前列环素未引起局部心肌氧摄取的变化，表明前列环素未诱导直接的冠状动脉血管舒张。在前列环素输注期间，未出现心电图或明显的心肌缺血代谢迹象。
前列环素可能是冠状动脉搭桥术后一种有用的降低后负荷的化合物，因为它没有直接的冠状动脉血管舒张作用，从而将心肌缺血风险降至最低。
