Kleinschmidt S, Grundmann U, Knocke T, Silomon M, Bach F, Larsen R
Department of Anaesthesiology and Critical Care Medicine, University of Saarland, Homburg, Saar, Germany.
Eur J Anaesthesiol. 1998 Sep;15(5):559-64. doi: 10.1046/j.1365-2346.1998.00353.x.
The haemodynamic effects of anaesthesia with gamma-hydroxybutyrate (GHB)/sufentanil for elective coronary artery bypass grafting (CABG) were investigated and compared in patients with unimpaired left ventricular function (ejection fraction > or = 45%, left ventricular end diastolic pressure < or = 16 mmHg) and patients with impaired left ventricular function. In 38 consecutive patients scheduled for CABG (21 with unimpaired and 17 with impaired left ventricular function), anaesthesia was induced with etomidate, sufentanil and pancuronium. After tracheal intubation, the lungs were normoventilated (end tidal Pco2 4.9-5.6 kPa) with an oxygen-air mixture (Fio2 0.5). Total intravenous anaesthesia was maintained with GHB (20 mg kg-1 h-1 after a 'priming dose' of 40 mg kg-1) and sufentanil (2 micrograms kg-1 h-1). Haemodynamic measurements were made after induction of anaesthesia and at various times in the prebypass period. Patients in both groups showed similar haemodynamic trends. Mean arterial pressure showed a maximum reduction of 10%, whereas heart rate and right- and left-sided filling pressures remained unchanged within the groups after the induction of anaesthesia. Cardiac index remained unchanged in both groups, although values differed between the groups. A total of 14 out of 21 patients (67%) with unimpaired and 10 out of 17 patients (59%) with impaired ventricular function required supplementary administration of opioids to control temporary hypertension after sternotomy. No episodes of myocardial ischaemia were detected during the study period using ST segment analysis (leads II and V5). The results of this study suggest that GHB provides adequate haemodynamic conditions in the prebypass period and may be a suitable agent for TIVA also in patients with impaired left ventricular function undergoing CABG.
研究并比较了γ-羟基丁酸（GHB）/舒芬太尼麻醉用于择期冠状动脉旁路移植术（CABG）时，对左心室功能未受损（射血分数≥45%，左心室舒张末期压力≤16 mmHg）和左心室功能受损患者的血流动力学影响。在38例连续安排行CABG的患者中（21例左心室功能未受损，17例左心室功能受损），用依托咪酯、舒芬太尼和潘库溴铵诱导麻醉。气管插管后，用氧气-空气混合气体（Fio2 0.5）使肺进行正常通气（呼气末Pco2 4.9 - 5.6 kPa）。用GHB（在40 mg·kg-1的“负荷剂量”后20 mg·kg-1·h-1）和舒芬太尼（2 μg·kg-1·h-1）维持全静脉麻醉。在麻醉诱导后及体外循环前的不同时间进行血流动力学测量。两组患者显示出相似的血流动力学趋势。平均动脉压最大降低10%，而麻醉诱导后组内心率以及左右侧充盈压保持不变。两组心脏指数均保持不变，尽管两组间数值有所不同。21例左心室功能未受损的患者中有14例（67%），17例左心室功能受损的患者中有10例（59%）在胸骨切开术后需要补充使用阿片类药物以控制短暂性高血压。在研究期间，使用ST段分析（II导联和V5导联）未检测到心肌缺血发作。本研究结果表明，GHB在体外循环前期可提供足够的血流动力学条件，对于行CABG的左心室功能受损患者，它可能也是一种合适的全静脉麻醉药物。
