硫喷妥钠-安定诱导、N_2O-异氟醚维持麻醉对二尖瓣直视手术病人血流动力学的影响

Hemodynamic Effects of Thiopental-Diazepam and N_2O-Isoflurane in Patients Undergoing Open Mitral Valvular Operation

对21例采用小剂量硫喷妥钠-安定诱导、N_2O-异氟醚吸入维持的二尖瓣直视手术病人进行了血流动力学测定。组Ⅰ(7例)术前临床心功能为Ⅱ级,组Ⅱ(14例)为Ⅲ～Ⅳ级。结果:①诱导后两组病人的CI及SI均减低,组Ⅱ尚伴有MAP及MPAP降低。气管插管后组Ⅰ的CI及MAP短暂增加。②劈胸骨后组Ⅱ的PVR明显增加。③主动脉及腔静脉插转流管后组ⅡMPAP、PVR、SVR及MAP均明显减低,但CI及SI较诱导后有所增加,并接近术前值。结果提示:对于心功Ⅱ级的二尖瓣病变病人采用小剂量硫喷妥钠诱导应属可取;但对心功Ⅲ～Ⅳ级病人应格外慎重。心功差者采用吸入1％以下异氟醚维持亦称安全,尤适用于伴有低排高阻者。

The hemodynamic effects of anesthetic induction with low-dose thiopental-diazepam and maintenance with N_2O-isoflurane were studied in 21 patients undergoing open mitral valvular operation. The patients were divided into two groups based on their clinical cardiac function before surgery. Group Ⅰ, 7 patients with cardiac function of class Ⅱ, and group Ⅱ, 14 patients, of class Ⅲ～Ⅳ. The results were; 1, Anesthetic induction produced decreases in CI and SI in both groups and MAP, MPAP in group Ⅱ. After endotracheal intubation, CI and MAP in group Ⅰ increased transiently. 2, After sternotomy PVR in group Ⅱ increased significantly. 3. After cannulation of aorta and vena cava, MPAP, PVR, SVR and MAP in group Ⅱ decreased significantly, CI and SI in both groups were higher than the values following induction and nearly returned to the controls. The results suggest that although thiopental has an adverse effect on cardiovascular syetem, it be suitable for patients with mitral diseases and classification Ⅱ cardiac function as long as the dosage and rate of injection were well controlled. In those with classification Ⅲ～Ⅳ, however, thiopental might further depress their impaired cardiovascular function. The results also suggest that giving less than 1% isoflurane might be quite (?)safe especially in those with low CO and high SVR.