Hemodynamic Effects of Doxacurium Chloride in Patients Receiving Oxygen Sufentanil Anesthesia for Coronary Artery Bypass Grafting or Valve Replacement
Hemodynamic Effects of Doxacurium Chloride in Patients Receiving Oxygen Sufentanil Anesthesia for Coronary Artery Bypass Grafting or Valve Replacement
复制标题
氯化多沙库铵对接受舒芬太尼氧麻醉进行冠状动脉搭桥术或瓣膜置换术的患者的血流动力学影响
DOI：
10.1097/00000542-198809000-00013
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发表时间：
1988
期刊：
影响因子：
8.8
通讯作者：
M. Abou
中科院分区：
文献类型：
--
作者：
C. M. Stoops;Charles A. Curtis;D. Kovach;R. L. McCammon;Robert K. Stoolting;T. M. Warren;Deborah Miller;M. Abou
多沙库铵氯化物是一种研究长效神经肌肉阻滞药物，已被证明是没有心血管副作用时，在适度剂量给药于健康患者。这是第一个多沙库铵在成人心脏病患者中的血流动力学研究。41例计划接受心脏手术的患者进行了研究。麻醉包括咪达唑仑0.2-0.3 mg/kg和舒芬太尼0.01-0.03 mg诱导，随后以0.03-0.06 mg ± min-1输注舒芬太尼。在舒芬太尼麻醉稳定状态下收集基线血流动力学数据。然后以ED 95 0.025 mg/kg的1、2或3倍剂量给予多沙库铵。在没有手术刺激的情况下，在多沙库铵注射后2、5和10分钟重复血流动力学测量。另一组对照患者接受生理盐水而不是多沙库铵。各组之间的基线血流动力学测量结果相似。随着时间的推移，所有组的心率均略有下降。然而，接受多沙库铵的患者组与对照组之间没有显著差异，其中心率从基线时的52次/分钟逐渐降低至多沙库铵给药后10分钟的49次/分钟。平均动脉压、右心房压或心输出量无任何显著变化。同样，推导出的血流动力学变量（包括心脏指数、每搏输出量和肺血管阻力）无变化。除心率降低外，血流动力学变化（达到统计学显著性）在临床上不显著，主要发生在接受多沙库铵0.08 mg/kg的患者组中。基线肺动脉闭塞压为13 mmHg，在2、5和10 min时分别升高至14、15和15 mmHg。因此，肺血管阻力从基线时的139 dyne · s · cm-5分别下降到2、5和10分钟时的114、103和102 dyne · s · cm-5。在接受最大剂量的该组患者中，每搏输出量在10分钟时也从67 ml显著增加至74 ml。可以得出结论，多沙库铵在剂量高达其ED 95的3倍时对测量或推导的血流动力学变量无临床显著影响。这种作用持续时间长和无循环效应的组合使多沙库铵成为心脏储备有限的患者进行长期手术的潜在有用药物。
Doxacurium chloride is an investigational long-acting neuromuscular blocking drug, which has been shown to be devoid of cardiovascular side effects when administered in modest doses to healthy patients. This is the first hemodynamic study of doxacurium in adult patients with cardiac disease. Forty-one patients scheduled to undergo cardiac surgery were studied. Anesthesia consisted of induction with midazolam 0.2–0.3 mg/kg and sufentanil 0.01–0.03 mg followed by an infusion of sufentanil at 0.03–0.06 mg ± min−1. Baseline hemodynamic data were collected during a stable state of sufentanil anesthesia. Doxacurium was then administered in doses of 1, 2, or 3 times its ED95 of 0.025 mg/kg. Hemodynamic measurements were repeated at 2, 5, and 10 min after doxacurium injection in the absence of surgical stimulation. An additional group of control patients received saline instead of doxacurium. Baseline hemodynamic measurements were similar among groups. There was a slight decrease in heart rate in all groups over time. However, there was no significant difference between the groups of patients receiving doxacurium and the control group in which the heart rate decreased progressively from 52 beats/min at baseline to 49 beats/min 10 min after doxacurium administration. At no time was there any significant change in mean arterial pressure, right atrial pressure, or cardiac output. Likewise derived hemodynamic variables including cardiac index, stroke volume, and pulmonary vascular resistance were unchanged. In addition to the decrease in heart rate, the hemodynamic changes, which reached statistical significance, were clinically insignificant and occurred predominantly in the group of patients receiving doxacurium 0.08 mg/kg. Baseline pulmonary artery occlusion pressure was 13 mmHg, and it increased to 14, 15, and 15 mmHg at 2, 5, and 10 min, respectively. Accordingly, pulmonary vascular resistance fell from 139 dyne · s · cm−5 at baseline to 114, 103, and 102 dyne · s · cm−5 at 2, 5, and 10 min, respectively. There was also a significant increase in stroke volume from 67 to 74 ml at 10 min in this group of patients receiving the largest dose. It is concluded that doxacurium has no clinically significant effect on measured or derived hemodynamic variables at doses up to 3 times its ED95. This combination of a long duration of action and absence of circulatory effects makes doxacurium a potentially useful drug for patients with limited cardiac reserve undergoing prolonged operations.