Unetani H, Nakao M, Kawaguchi R, Nakatani K, Hazama K, Kajiyama S
Division of Anesthesia and Intensive Care Medicine, Hiroshima Prefectural Hiroshima Hospital.
Masui. 1998 Feb;47(2):208-12.
A 69 year-old male with ischemic heart disease indicated for coronary artery bypass grafting was scheduled for carotid microendoarterectomy. We induced mild hypothermia technique with vasodilation and surface cooling by convecting warming device. We examined hemodynamics by pulmonary artery catheter. Anesthesia was induced with thiamylal, fentanyl, midazolam and isoflurane in nitrous oxide and oxygen. Following administration of vecuronium, trachea was intubated. Pulmonary artery catheter was inserted from the femoral vein. Dopamine, dobutamine 3-5 micrograms.kg-1.min-1 and PGE1 5-10 ng.kg-1.min-1 were continuously administered to keep peripheral blood circulation and cardiac output (CO). Systemic vascular resistance decreased from 1800 to 591 dyne.s.cm-5 and CO increased from 2.8 to 6.9 l.min-1. The occlusion of blood flow of the right carotid artery for 40 min at 34.5 degrees C of rectal temperature did not cause any neurological deficits. No other complications such as arrhythmia, myocardial ischemia and bleeding tendency were observed. Keeping peripheral blood circulation and uniform cooling and warming are important in inducing mild hypothermia safely in a patient with ischemic heart disease.
一名69岁患有缺血性心脏病且拟行冠状动脉搭桥术的男性患者计划接受颈动脉内膜剥脱术。我们采用血管扩张和通过对流式加温装置进行体表降温的方法诱导轻度低温技术。我们通过肺动脉导管检查血流动力学。麻醉诱导使用硫喷妥钠、芬太尼、咪达唑仑以及一氧化二氮和氧气中的异氟烷。给予维库溴铵后进行气管插管。从股静脉插入肺动脉导管。持续给予多巴胺、3 - 5微克·千克⁻¹·分钟⁻¹的多巴酚丁胺以及5 - 10纳克·千克⁻¹·分钟⁻¹的前列地尔以维持外周血液循环和心输出量（CO）。全身血管阻力从1800降至591达因·秒·厘米⁻⁵，心输出量从2.8升·分钟⁻¹增至6.9升·分钟⁻¹。在直肠温度34.5℃时，右侧颈动脉血流阻断40分钟未引起任何神经功能缺损。未观察到心律失常、心肌缺血和出血倾向等其他并发症。在缺血性心脏病患者中安全诱导轻度低温时，维持外周血液循环以及均匀的降温和升温很重要。
