钙通道阻滞剂伊拉地平减轻右美托咪定的外周血流动力学效应。

Alleviation of the peripheral hemodynamic effects of dexmedetomidine by the calcium channel blocker isradipine.

作者信息

Roekaerts P M, Lawrence C J, Prinzen F W, de Lange S

机构信息

Department of Anesthesiology, University Hospital of Maarstricht, The Nederlands.

出版信息

Acta Anaesthesiol Scand. 1997 Mar;41(3):364-70. doi: 10.1111/j.1399-6576.1997.tb04700.x.

DOI:10.1111/j.1399-6576.1997.tb04700.x

PMID:9113181

Abstract

BACKGROUND

Alpha 2-adrenergic agonists have peripheral vasoconstrictive effects and central sympatholytic and sedative effects. Whereas the latter are the basis of their use in anesthesia, the former could limit their clinical application.

METHODS

To study whether a vasodilator could alleviate the systemic and coronary vasoconstrictor effects of dexmedetomidine without influencing the central sympatholytic effects, the calcium channel blocker isradipine was infused after a high dose of dexmedetomidine in anesthetized dogs.

RESULTS

Dexmedetomidine 10 micrograms.kg-1 decreased plasma concentrations of norepinephrine and epinephrine by more than 90%, heart rate by 39%, cardiac output by 64%, dp/dtmax by 29% and increased mean arterial pressure by 55% and the left ventricular end-diastolic pressure (LVEDP) 4-fold as compared to baseline. In addition, coronary blood flow decreased by 52% and coronary venous oxygen saturation by 51%. Isradipine could completely antagonize all the coronary and systemic hemodynamic changes induced by dexmedetomidine, but only partially he increase in LVEDP. Isradipine caused no changes in plasma catecholamine levels.

CONCLUSION

Isradipine could alleviate the peripheral hemodynamic actions of dexmedetomidine while having no effect on its central sympatholytic properties.

摘要

背景

α2肾上腺素能激动剂具有外周血管收缩作用以及中枢性抗交感神经和镇静作用。虽然后者是其在麻醉中应用的基础，但前者可能会限制其临床应用。

方法

为研究血管扩张剂是否能减轻右美托咪定的全身和冠状动脉血管收缩作用而不影响其中枢性抗交感神经作用，在麻醉犬中给予高剂量右美托咪定后输注钙通道阻滞剂伊拉地平。

结果

与基线相比，10微克·千克−1的右美托咪定使去甲肾上腺素和肾上腺素的血浆浓度降低超过90%，心率降低39%，心输出量降低64%，dp/dtmax降低29%，平均动脉压升高55%，左心室舒张末期压力（LVEDP）升高4倍。此外，冠状动脉血流量减少52%，冠状静脉血氧饱和度降低51%。伊拉地平可完全拮抗右美托咪定引起的所有冠状动脉和全身血流动力学变化，但仅部分拮抗LVEDP的升高。伊拉地平对血浆儿茶酚胺水平无影响。