Ishii R, Akazawa S, Shimizu R, Nakaigawa Y, Ikeno S, Yamato R
Department of Anaesthesiology, Ohmiya Red Cross Hospital, Tochigi, Japan.
Br J Anaesth. 1996 Sep;77(3):393-8. doi: 10.1093/bja/77.3.393.
We have studied the effects of adenosine-induced hypotension on A-H interval (atrioventricular (AV) nodal conduction time during sinus rhythm), St-H interval (intra-atrial plus AV nodal conduction time during atrial pacing), H-V interval (His-Purkinje conduction time) and H-S interval (total ventricular conduction time) by His-bundle electrocardiography in addition to surface electrocardiogram during both sinus rhythm and atrial pacing in nine dogs anaesthetized with 1 MAC of sevoflurane. Stepwise increases in infusion rates of adenosine to 0.1, 0.3, 0.5 and 1.0 mg kg-1 min-1 produced a dose-related decrease in mean arterial pressure from 91 (6) to 38 (2) mm Hg. Adenosine significantly increased the A-H interval at infusion rates of 0.5 mg kg-1 min-1 and above, and the St-H interval at 1.0 mg kg-1 min-1. The H-V and H-S intervals remained unchanged. Heart rate decreased significantly only at 1.0 mg kg-1 min-1 with a significant increase in the PR interval. Adenosine-induced hypotension did not have deleterious effects on AV conduction times and the surface electrocardiogram in dogs anaesthetized with 1 MAC of sevoflurane. This may indicate that the effects of adenosine on AV conduction were small and therefore are unlikely to be a contraindication to the use of adenosine for inducing hypotension in patients with initially normal conduction during sevoflurane anaesthesia.
我们采用希氏束心电图检查,研究了腺苷诱导的低血压对9只吸入1 MAC七氟醚麻醉犬在窦性心律和心房起搏时的A-H间期(窦性心律时房室(AV)结传导时间)、St-H间期(心房起搏时心房内加房室结传导时间)、H-V间期(希氏-浦肯野传导时间)和H-S间期(总心室传导时间)的影响,同时记录体表心电图。将腺苷输注速率逐步提高到0.1、0.3、0.5和1.0 mg·kg⁻¹·min⁻¹,可使平均动脉压从91(6)mmHg降至38(2)mmHg,呈剂量依赖性。腺苷输注速率在0.5 mg·kg⁻¹·min⁻¹及以上时,显著增加A-H间期;输注速率为1.0 mg·kg⁻¹·min⁻¹时,显著增加St-H间期。H-V间期和H-S间期保持不变。仅在输注速率为1.0 mg·kg⁻¹·min⁻¹时心率显著降低,PR间期显著延长。腺苷诱导的低血压对吸入1 MAC七氟醚麻醉犬的房室传导时间和体表心电图无不良影响。这可能表明,腺苷对房室传导的影响较小,因此在七氟醚麻醉期间,对于初始传导正常的患者,腺苷诱导低血压不太可能成为使用腺苷的禁忌证。