汉肌松持续控制性降压期的血流动力及呼吸动力的观察

HEMODYNAMIC AND RESPIRATORY DYNAMIC OBSERVATIONS DURING TETRADRINE DIMETHIODIDE(HCS)INDUCED CONTINUOUS HYPOTENSION

9只狗在五烷巴比妥静脉麻醉下分别静脉滴注汉肌松(HCS)或ATP降压;血流动力变化用Swan-Ganz漂浮导管和Gould IM1000电脑心脏监护仪测定,呼吸动力变化用多功能呼吸监护仪测定。HCS低压期间HR,SVR,LVSWI,和MVO_2呈显著降低,CI,SI,CVP,PAP,PCWP,PVR和RVSWI无显著变化。ATP降压期间SI显著增高,PVR,RVSWI显著降低。HCS或ATP降压期均无肺顺应性、气道阻力及气道峰值压力变化。HCS降压期吸气平台压显著降低,而ATP降压期无此变化。结果表明用HCS持续降压的优点是降压起效快、停药后复压快,可维持恒定的低压水平、左心负荷减轻、心肌氧耗量减少,无快速耐药性及复压期反跳性高血压和心动过速。二者的主要区别,HCS兼有弱的肌肉松弛作用,ATP使心脏每搏量增高和使右心负荷显著增高。HCS和ATP相似,可用于临床降压。

The purpose of these experiments was to show the hemodyna-mic and respiratory dynamic effects of HCS induced continuous hypotension.9 dogs anesthetized with Pentobarbital were studied with intravenous titrate HCS or ATP.Hemodynamic changes were measured with Swan-Ganz catheter and Gould IM 1000 computer cardiac monitor.Respiratory dynamic changes were measured with multi-function respiratory monitor.HCS induced hypoten-sion was associated with significant decreases in HR,SVR,LVSWI,MVO_2,and no significant changes in CI,SI,CVP,PAP,PCWP,PVR and RVSWI.Hypotension induced with ATP was associated with a significant increase in SI and decrease in PVR and RVSWI.Lung compliance,air way resistance and peak pressure does not change at induced hypotension with either HCS or ATP.Inspiration plateau pressure was decreased significantly at HCS induced hypotension and does not change at ATP induced hypotension.The results indicate that HCS has certain adventages for the induction of continuous hypotension.These include rapid onset of hypotensive action,quickly recovers when the infusion is terminated,easy to maintain a constant hypotensive level by titrating the HCS dose,left cardiac toad and cardiac oxygen consumption were decreased and tachyphylaxis,rebound hypertension and tachycardia did not appear to be a problem.Major differences between the two drugs were apparent in skeletal muscle,where HCS is a weak muscle relaxant,an in the heart,where ATP is associated with increases in cardiac output and increa-ses in right cardiac load.These studies indicate that HCS,like ATP,are adventages in the consideration as a continuous hypotensive agent in clinical practice.