大剂量吗啡、芬太尼及纳络酮对犬冠脉血流影响的实验研究

Effect of morphine, fentanyl and naloxone on coronary blood flow in the dog.

实验用犬９只，开胸分离冠脉左旋支，安置电磁流量仪探头，监测冠脉血流量（ＣＢＦ）。同时用生理多异议监测左室收缩压（ＬＶＳＰ）、平均动脉压（ＭＡＰ）、心率（ＨＲ）和心电图（ＥＣＧ）。给药前各指标为对照值。第１组６只，静注吗啡２ｍｇ·ｋｇ－１和纳络酮０．１ｍｇ·ｋｇ－１加吗啡２ｍｇ·ｋｇ－１。第２组３只，静注芬太尼１００ｕｇ·ｋｇ－１。结果表明：吗啡使冠脉血流量增加５６．８％，同时有ＬＶＳＰ、ＭＡＰ下降，ＨＲ无变化。上述作用可被纳络酮部分拮抗。芬太尼使ＨＲ、ＣＢＦ、ＬＶＳＰ、ＭＡＰ 下降，对循环功能有一定抑制作用。提示大剂量芬太尼用于心脏患者麻醉要慎重。而吗啡有扩张冠脉作用，用于心脏患者麻醉有利于体外循环后心脏复跳，尤其对心肌缺血患者麻醉有益。

Electromagnetic blood flowmeter (EBF) and polygraph system were used for measuring the coronary blood flow (CBF), left ventricular systolic pressure (LVSP),mean aortic pressure (MAP ), heart rate respectively in anesthetized dogs. In group 1 (6 dogs ), after opening the chest,the left coronary artery was surrounded by a fitting flow prob of EBF and ploygraph system was connected with dogs. morphine (2mg. kg-1 ),morphine plus naloxone were intravenously injected into dogs respectively. It showed that CBF was increased 56. 8% with morphine, while the LVSP and MAP decreased, HR not changed. The effect mentioned above were partly antagonized by naloxone (0. 4mg/kg). In group 2(3 dogs) using same methods, HR.CBF. LVSP and MAP were decreased with high dose fentanyl (100ug/kg ). The results suggested that in clinic the use of high dose fentanyl should be careful during anesthesia for the patients with cardiopathy. However, the effect of morphine in increasing CBF may be beneficial for the patients with myocardial ischemia.