Terashima M, Watanabe K, Iwama H, Kawamae K, Tase C, Okuaki A
Division of Cardiology, Sendai Shakaihoken Hospital.
Masui. 1997 Jan;46(1):110-3.
This study examines the effects of induced hypotension with intravenous administration of nicardipine hydrochloride (NIC) upon pulmonary arterial pressure (PAP) undergoing modified radical mastectomy with neuroleptanesthesia (NLA-group; 3 cases) and inhalation anesthesia (N2O+ isoflurane; GOI-group; 3 cases). Systolic arterial pressure was reduced and maintained at 80 mmHg. During and after induced hypotension in NLA-group, heart rate (HR), cardiac index, pulmonary arterial pressure (PAP) increased remarkably. On the other hand, systemic vascular resistance index was reduced. In GOI group, no significant changes were seen in PAP. The acceleration of the autonomic baro-reflex induced by decreased blood pressure produced by NIC may be depressed under anesthesia to initiate this difference in response of HR to NIC. The data indicate that this depressive effect of NLA on this reflex is weak, and NIC is a potent systemic vasodilator with hyperdynamic hemodynamic effects in addition to an increase in right ventricular function, and PAP was increased.
本研究考察了静脉注射盐酸尼卡地平(NIC)诱导低血压对在神经安定麻醉(NLA组;3例)和吸入麻醉(N2O+异氟烷;GOI组;3例)下行改良根治性乳房切除术时肺动脉压(PAP)的影响。动脉收缩压降低并维持在80 mmHg。在NLA组诱导低血压期间及之后,心率(HR)、心脏指数、肺动脉压(PAP)显著升高。另一方面,全身血管阻力指数降低。在GOI组,PAP未见显著变化。NIC导致的血压下降所诱发的自主压力反射加速在麻醉状态下可能受到抑制,从而引发HR对NIC反应的这种差异。数据表明,NLA对该反射的这种抑制作用较弱,并且NIC是一种强效的全身血管扩张剂,除了增加右心室功能外还具有高动力血流动力学效应,且PAP升高。