Nishida T, Taniguchi A, Tanigami H, Hagihira S, Yoshiya I
Department of Anesthesiology, Osaka University Medical School, Suita.
Masui. 1996 Oct;45(10):1265-8.
Restrictive cardiomyopathy is a rare condition characterized with endomyocardial fibrosis, which interferes diastolic ventricular filling. A 52-year-old man with a 38 year history of dyspnea on effort presented with advanced gastric cancer. Subtotal gastrectomy under general anesthesia was scheduled. Preoperative examination showed biventricular dysfunction, impaired liver function and chronic renal failure. General anesthesia was induced using fentanyl, pancuronium and isoflurane, and maintained with nitrous oxide/oxygen, isoflurane and fentanyl. Extensive invasive monitoring included arterial blood pressure, central venous pressure, pulmonary artery pressure and oxygen saturation of mixed venous blood as indices of left-sided pump function. Dopamine and nitroglycerin infusion was also started after the tracheal intubation. Although a transient improvement of cardiac function was noted after the removal of ascites 5 liter, restricted fluid administration induced desaturation of mixed venous blood and tachycardia. The start of low dose prostaglandin E1 markedly improved cardiac output without hypotension, while an increase of intravenous nitroglycerin did not prove to be beneficial. PGE1 was more selective in decreasing left ventricular afterload, while nitroglycerin produces greater decrease of preload.
限制型心肌病是一种罕见的疾病，其特征为心内膜纤维化，这会干扰心室舒张期充盈。一名有38年劳力性呼吸困难病史的52岁男性，因晚期胃癌前来就诊。计划在全身麻醉下行胃大部切除术。术前检查显示双心室功能障碍、肝功能受损和慢性肾衰竭。使用芬太尼、泮库溴铵和异氟烷诱导全身麻醉，并以氧化亚氮/氧气、异氟烷和芬太尼维持。广泛的有创监测包括动脉血压、中心静脉压、肺动脉压和混合静脉血氧饱和度，作为左侧泵功能的指标。气管插管后还开始输注多巴胺和硝酸甘油。尽管在抽出5升腹水后心脏功能有短暂改善，但限制液体输入导致混合静脉血饱和度降低和心动过速。开始使用低剂量前列腺素E1可显著改善心输出量且无低血压，而增加静脉硝酸甘油用量并未显示有益。前列腺素E1在降低左心室后负荷方面更具选择性，而硝酸甘油对前负荷的降低作用更大。
