EFFFCTS OF HYPOTENSIVE ANESTHESIA ON CORONARY ARTERY AND MYOCARDIUM DURING ORAL SURGERY

口腔手术中低血压麻醉对冠状动脉和心肌的影响

基本信息

批准号：
60570919
负责人：
ITO Hiromichi
金额：
$ 1.02万
依托单位：
TOKYO MEDICAL AND DENTAL UNIVERSITY
依托单位国家：
日本
项目类别：
Grant-in-Aid for General Scientific Research (C)
财政年份：
1985
资助国家：
日本
起止时间：
1985 至 1987
项目状态：
已结题

来源：
https://kaken.nii.ac.jp/grant/KAKENHI-PROJECT-60570919/
关键词：
Induced Hypotension ATP Prostaglandin E1 Nitroglycerine Coronary Artery Myocardial Regional Blood Flow Myocardial Regional Oxygen Tension 口腔外科手術冠血管系心筋外層酸素電極法

项目摘要

I. Experimental study:The subendocardium is known to be the most vulnerable ergion of the heart to ischemic or hypoxic injury. The purpose of this study was to examine and compare the changes of 1) myocardial tissue oxygen tension(PO2, mmHg) and 2) regional blood flow (BF, ml/100g/min) by direct online measurement from the living myocardium during induced hypotension with nitroglycerine (NTG),isoflurane (ISO) or adenosine triphosphate (ATP). In normal heart, during drug induced graded hypotension, epicardial layer perfusion and metabolic activity were relatively well maintained. Endocardial layer PO2 was most affected and disturbed which was accompanied by various degrees of BF changes: NTG causing the most, and ATP the least changes. Thus, we conclude that although NTG is considered a good myocardial vasodilator, this is not necessarily so during hypotension.With ATP, both myocardial BF and PO2 values were maintained well above 80% of control in all stages of hypotension.II. Clinical study:ATP, prostaglandin E1 and nitroglycerine are known to be potent and extremely short acting vasodilators, producing transient but profound hypotension. For this reason, these. agents have been particularly suited for short time surgical procedures which require rapid control of blood pressure. When hypotension is needed for long periods, the large doses of vasodilators may be required.In this study, we found that dipyridamode reduced the ATP dose requirement to 1/10 to 1/15 to attain the same BP reduction. ATP/Dipyridamole showedvery favorable effects on both cardiovascular (includes coronary artery) and metabolic parameters during and after prolonged infusion (>4 hrs) in man. No deleterious or adverse changes were detected in neither blood nor ruine. Thus, the ATP/Dipyridamole combination can be more safely used chinically than prostaglandin E1 or nitroglycerine.

I.实验研究：心内膜下心脏是心脏最脆弱的缺血性或缺氧损伤。这项研究的目的是检查和比较1）心肌组织氧张力（PO2，MMHG）和2）通过直接在线心肌进行直接在线测量的区域血流（BF，ML/100G/MIN），该测量在诱导的低体性降低性心肌（氮气（NTG），Isoflurane（isoflurane）（Isoflurane）（Isoflurane（Isoflurane）（Isoflurane（Isof）））或adneosine（Isoflurane（Isoflurane（Isoflurane）））或adneosine（athe）或adneosine（Isoflurane（Isoflurane）或adneosine）中。在正常的心脏中，在药物诱导的低血压，心外膜层灌注和代谢活性相对较好地维持。心内膜层PO2受到最大的影响和干扰，伴随着不同程度的BF变化：NTG导致最大的变化，而ATP的变化最少。因此，我们得出的结论是，尽管NTG被认为是良好的心肌血管扩张剂，但在低血压期间不一定是如此。在ATP中，在Hypotension.ii的所有阶段，心肌BF和PO2值均保持远高于控制的80％。临床研究：已知ATP，Prostaglandin E1和硝酸甘油具有有效且极短的作用加速器，产生了短暂的但深刻的低血压。因此，这些。药物特别适合短期手术程序，需要快速控制血压。长期需要低血压时，可能需要大剂量的血管扩张剂。在这项研究中，我们发现二吡啶二极管将ATP剂量的需求降低至1/10至1/15，以减少相同的BP。 ATP/Dipyridamole在人体长期输注（> 4小时）期间和之后对心血管（包括冠状动脉）和代谢参数均表现出非常有利的作用。在血液或破坏中均未检测到有害或不利的变化。因此，与前列腺素E1或硝酸甘油相比，ATP/Dipyridamole组合可以更安全地使用。