芬太尼与丙泊酚对心肌顿抑期间左心室收缩性影响的比较

A comparison of the effects of fentanyl and propofol on left ventricular contractility during myocardial stunning.

作者信息

Ross S, Muñoz H, Piriou V, Ryder W A, Foëx P

机构信息

The Nuffield Department of Anaesthetics, The Radcliffe Infirmary, University of Oxford, England, United Kingdom.

出版信息

Acta Anaesthesiol Scand. 1998 Jan;42(1):23-31. doi: 10.1111/j.1399-6576.1998.tb05076.x.

DOI:10.1111/j.1399-6576.1998.tb05076.x

PMID:9580055

Abstract

BACKGROUND

The intravenous anaesthetic propofol has been shown to possess free radical scavenging activity and calcium channel blocking effects in a number of in vitro models. We decided to compare the effects of propofol with those of fentanyl on myocardial contractility during and after ischaemia to determine whether propofol could protect the heart and improve recovery of ventricular contractile function in open-chested dogs.

METHODS

Twenty adult beagles were acutely instrumented, under halothane anaesthesia, to measure ECG; aortic, left ventricular pressures; cardiac output; coronary flow; and segmental lengths in the regions perfused by the left anterior and left circumflex coronary arteries. After surgery and a stabilisation period halothane anaesthesia was terminated and fentanyl (100 microg x kg[-1] bolus followed by 2 microg x kg[-1] x min[-1] infusion; n=10) or propofol (5 mg x kg[-1] bolus followed by 0.3 mg x kg[-1] x min[-1] infusion; n=10) anaesthesia commenced. After a stabilisation period the LAD coronary artery was occluded for 10 min and then reperfused for 3 h. Measurements were taken throughout the protocol.

RESULTS

We found no significant difference in recovery of contractile function between propofol and fentanyl as assessed by normalised preload recruitable work area (50+/-10 vs 47+/-16%), normalised systolic shortening (36+/-12 vs 48+/-14%) and peak left ventricular dP/dt (1665+/-276 vs 1846+/-151 mmHg x s[-1]) at the end of reperfusion.

CONCLUSION

We conclude that at the concentration used in this study propofol shows no improvement in contractility during "stunning" when compared to fentanyl.

摘要

背景

在许多体外模型中，静脉麻醉药丙泊酚已被证明具有自由基清除活性和钙通道阻滞作用。我们决定比较丙泊酚和芬太尼在缺血期间及之后对心肌收缩力的影响，以确定丙泊酚是否能保护心脏并改善开胸犬心室收缩功能的恢复。

方法

20只成年比格犬在氟烷麻醉下进行急性仪器植入，以测量心电图、主动脉压、左心室压、心输出量、冠状动脉血流量以及左前降支和左旋支冠状动脉灌注区域的节段长度。手术和稳定期后，终止氟烷麻醉，开始芬太尼（100μg·kg⁻¹推注，随后2μg·kg⁻¹·min⁻¹输注；n = 10）或丙泊酚（5mg·kg⁻¹推注，随后0.3mg·kg⁻¹·min⁻¹输注；n = 10）麻醉。稳定期后，闭塞左前降支冠状动脉10分钟，然后再灌注3小时。在整个实验过程中进行测量。