不同浓度氨氟醚对循环功能的影响

The Influence of Enflurane with Different Concentrations on the Circulation

目的 :探讨氨氟醚呼末浓度与血流动力学的关系。方法 :选择ASAⅠ～Ⅱ级择期腹腔镜胆囊切除术病人 12例 ,静脉诱导插管后麻醉机控制呼吸 ,经右颈内静脉穿刺置入F7SwanGanz漂浮导管监测中心静脉压 (CVP)、肺毛细血管嵌压 (PCWP)和平均肺动脉压 (MPAP) ,桡动脉穿刺测平均动脉压 (MAP) ,温度稀释法测心输出量(CO) ,并计算心脏指数 (CI)、每搏指数 (SI)、左室每搏功指数 (LVSWI)、体循环阻力指数 (SVRI)和肺循环阻力指数 (PVRI)。通过Drager19 1蒸发器吸入氨氟醚 ,监测呼气末氨氟醚浓度 ,记录不同氨氟醚浓度下各血流动力学指标的变化。结果 :随着氨氟醚浓度的增加 ,MAP、CI、SI、LVSWI进行性下降 ,当氨氟醚浓度为 1%时 ,上述指标下降已相当明显 ,P <0 0 1～ 0 0 5 ;氨氟醚浓度与各指标相关性均比较强 ,相关系数分别为 - 0 98、 -0 98、 - 0 97、 - 0 98。平均肺动脉压的变化不及MAP明显 ,HR、CVP、PCWP、SVR、PVRI均未发生显著变化。结论 :氨氟醚能剂量依赖性地抑制循环功能 ,并可根据MAP的抑制情况粗略估计氨氟醚的呼末浓度。由于氨氟醚循环抑制作用比较显著 ,临床上不能单独以其维持麻醉。

Objective:To investigate the relationship between end-tidal (E-T) Enflurane concerltration and hemodynamics.Methods:12 patients of ASA Ⅰ～Ⅱ scheduled for laparoscopic cholesystectomy were sclected.Their respiration was controlled by anesthesia machine after intravenous induction and intubation.The CVP、PCWP、MPAP were supervised by F7 Swan-Ganz floating tube catheterized through right internal jugular veino.The MAP was measured by radial artery puncture.Cardiac Output (CO) was measured by temperature dilution method and CI、SI、LVSWI、SVRI、PVRI were calculated.Enflurane was inhaled through Drager 19 1 vaporizer.The E-T Enflurane concentration was supervised and the changes of each hemodynamic index under different Enflurane concentrations were recorded.Results:The MAP、CI、SI and LVSWI decreased progressively as Enflurane concentration increased.The above indexes had already decreased obviously when Enflurane concentration reached 1% ( P <0 01～0 05).The correlations between Enflurane and each index were strong and the correlation coefficients were -0 98,-0 98,-0 97,-0 98 respectively.The variation of MPAP was less obvious than that of MAP and HR、CVP、PCWP、SVR and PVRI didn’t show obvious changes.Conclusions:The inhibition effect on circulation by Enflurane is dosedependent and E-T Enflurane concentration can be estimated according to the inhibitory degree of MAP.Enflurane can not be used alone to maintain anesthesia because it can inhibit circulation significantly.