Christiansen C L, Ahlburg P, Jakobsen C J, Andresen E B, Paulsen P K
Department of Anaesthesia, Skejby Hospital, Aarhus, Denmark.
J Cardiothorac Vasc Anesth. 1998 Aug;12(4):418-21. doi: 10.1016/s1053-0770(98)90195-1.
Because propofol is known to reduce vascular resistance, the objective of this study was to compare the indices of hepatosplanchnic circulation and oxygenation during cardiopulmonary bypass (CPB) in patients anesthetized with either propofol or midazolam/halothane.
A prospective, randomized, nonblinded study.
A university hospital.
Twenty patients undergoing cardiac surgery with CPB.
Nine patients were anesthetized with propofol/fentanyl/pancuronium and 11 patients were anesthetized with midazolam/halothane/fentanyl/pancuronium. All patients had a nasogastric tonometer tube and two fiberoptic thermodilution catheters inserted; one in the pulmonary artery and one in the upper right hepatic vein. During bypass, SvO2s were measured from the venous line of the heart-lung machine.
Gastric mucosal pH (pHi) was measured prebypass, 30 minutes after the start of CPB, and just before weaning off CPB. Hepatic SvO2 (HSvO2) values were recorded every 5 minutes. The pH gap was less at 30 minutes of hypothermic CPB in the propofol group. In the midazolam/halothane group, the HSvO2 decreased after the start of rewarming, whereas in the propofol group the values remained almost at the prebypass levels. At the end of rewarming, the HSvO2 was almost identical in the two groups.
Propofol preserved the HSvO2 during CPB and produced a more optimal relationship between the hepatosplanchnic blood flow and oxygen consumption.
由于已知丙泊酚可降低血管阻力，本研究的目的是比较丙泊酚或咪达唑仑/氟烷麻醉的患者在体外循环（CPB）期间肝内脏循环和氧合指标。
一项前瞻性、随机、非盲研究。
一家大学医院。
20例接受CPB心脏手术的患者。
9例患者采用丙泊酚/芬太尼/潘库溴铵麻醉，11例患者采用咪达唑仑/氟烷/芬太尼/潘库溴铵麻醉。所有患者均插入鼻胃张力计管和两根光纤热稀释导管；一根置于肺动脉，一根置于肝右静脉上部。在体外循环期间，从心肺机的静脉管路测量SvO2s。
在体外循环开始前、CPB开始后30分钟以及即将停止CPB前测量胃黏膜pH值（pHi）。每5分钟记录一次肝SvO2（HSvO2）值。丙泊酚组在低温CPB 30分钟时pH差值较小。在咪达唑仑/氟烷组，复温开始后HSvO2下降，而丙泊酚组的值几乎保持在体外循环前水平。复温结束时，两组的HSvO2几乎相同。
丙泊酚在CPB期间可维持HSvO2，并在肝内脏血流与氧消耗之间产生更优化的关系。
