在右室缺血再灌注中七氟醚比异丙酚提供更好的血流动力学稳定性
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Sevoflurane provides better haemodynamic stability than propofol during right ventricular ischaemia-reperfusion.
背景与目的
评价在急性右心室缺血再灌注中七氟醚是否比异丙酚具有更好的血流动力学稳定性。
方 法
用七氟醚（n=6）或丙泊酚（n=6）麻醉的开胸猪（68.8 ±4.2 kg）行右室游离壁缺血60 min，再灌注150 min。连续监测3条冠状动脉的血流动力学参数和血流。分析心肌缺血的生物标志物。
结 果
两组平均动脉压和心搏量均下降，肺血管阻力均增加。异丙酚组心率提高7.5%（p<0.05），七氟醚组心率提高17%（p<0.05）。再灌注时，七氟醚可降低左房压和全身血管阻力。而丙泊酚组的RV卒中（MMHG·ml）和心输出量（L·min -1）降低（分别为4.2±1.2～2.9±1.7和2.65±0.44～2.28±0.56，P＜0.05），恢复到七氟醚组的基线水平（4.1±1.5～4±4），α±4.1～α±4.1。p>0.05）。两组冠状动脉回旋支和左前降支血流均下降。右冠状动脉血流（ml·min-1）用异丙酚（38 9～28 9，p<0.05）降低，而用七氟醚（28 11～28 17，p＞两组心脏缺血的生物标志物均增加。再灌注时，七氟醚可降低左房压和全身血管阻力。丙泊酚组的右室作功指数（MMHG·ml）和心输出量（L·min -1）降低（分别为4.2±1.2至2.9±1.7和2.65±0.44至2.28±0.56，P＜0.05），而他们在丙泊酚组中恢复到了基线水平(4.1 ± 1.5至4.0 ± 1.5 and 2.77 ± 0.6 至2.6 ± 0.5, respectively, P > 0.05) 。两组冠状动脉回旋支和左前降支血流均下降，异丙酚组右冠状动脉血流（ml·min-1）（38± 9至28± 9，p<0.05）降低，而用七氟醚组则没有（28±11至28 ±17，p＞0.05).两组心脏缺血的生物标志物均增加。
结 论
与异丙酚相比，七氟醚麻醉猪在再灌注过程中右室舒张功、心排血量和右冠状动脉血流量均明显增加。这些发现为七氟醚治疗人类右心室缺血的临床试验提供了依据。
原始文献摘要
Haraldsen Pernille,Cunha-Goncalves Doris,Metzsch Carsten et al. Sevoflurane provides better haemodynamic stability than propofol during right ventricular ischaemia-reperfusion.[J] .Interact Cardiovasc Thorac Surg, 2019, undefined: undefined.
OBJECTIVES:To assess whether sevoflurane provides better haemodynamic stability than propofol in acute right ventricular (RV) ischaemia-reperfusion.
METHODS:Open-chest pigs (mean ± standard deviation, 68.8 ± 4.2 kg) anaesthetized with sevoflurane (n = 6) or propofol (n = 6) underwent 60 min of RV free wall ischaemia and 150 min of reperfusion. Haemodynamic parameters and blood flow in the 3 major coronary arteries were continuously monitored. Biomarkers of cardiac ischaemia were analysed.
RESULTS:Mean arterial pressure and stroke volume decreased, whereas pulmonary vascular resistance increased equally in both groups. Heart rate increased 7.5% with propofol (P < 0.05) and 17% with sevoflurane (P < 0.05). At reperfusion, left atrial pressure and systemic vascular resistance decreased with sevoflurane. While RV stroke work (mmHg·ml) and cardiac output (l·min-1) decreased in the propofol group (4.2 ± 1.2 to 2.9 ± 1.7 and 2.65 ± 0.44 to 2.28 ± 0.56, respectively, P < 0.05 both), they recovered to baseline levels in the sevoflurane group (4.1 ± 1.5 to 4.0 ± 1.5 and 2.77 ± 0.6 to 2.6 ± 0.5, respectively, P > 0.05). Circumflex and left anterior descending coronary artery blood flow decreased in both groups. Right coronary artery blood flow (ml·min-1) decreased with propofol (38 ± 9 to 28 ± 9, P < 0.05), but not with sevoflurane (28 ± 11 to 28 ± 17, P > 0.05). Biomarkers of cardiac ischaemia increased in both groups.
CONCLUSIONS:Compared to propofol, sevoflurane-anaesthetized pigs showed higher RV stroke work, cardiac output and right coronary artery blood flow during reperfusion. These findings warrant a clinical trial of sevoflurane in RV ischaemia in humans.
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翻译：符校魁 编辑：李华宇 审校：王贵龙