Right and Left Ventricular Responses to Aortic Unclamping Following Aortic Cross-Clamping. -Effects of Nitric Oxide Inhalation on Cardiac Performance Assessed by Transesophageal Echocardiography

主动脉交叉钳夹后右心室和左心室对主动脉松开的反应。

• 批准号: 08671724
• 负责人: AKAMATSU Shigeru
• 金额: $ 1.15万
• 依托单位: Gifu University
• 依托单位国家: 日本
• 项目类别: Grant-in-Aid for Scientific Research (C)
• 财政年份: 1996
• 资助国家: 日本
• 起止时间: 1996 至 1997
• 项目状态: 已结题
• 来源: https://kaken.nii.ac.jp/grant/KAKENHI-PROJECT-08671724/
• 关键词: Nitric oxide; Aortic unclamping; Hemodynamics; Pulmonary hypertension; Monitoring; Transesophageal echocardiography; Aortic Unelamping; Pulmonary Hypertension; 心機能; 大動脈遮断解除; 一酸化窒素

It is well known that abrupt changes in heumodynamics can occur after aortic cross-clamping (XC) and unclamping (XU) during abdominal aortic aneurysmectomy (AAAectomy). Several reports indicate that XU induces a significant rise in pulmonary arterial pressure. The rationale for hemodynamic management during AAAectomy is controversial. Vasodilators would decrease not only pulmonary vascular resistance (PVR), but also systemic vascular resistance (SVR), resulting in a fall in arterial pressure. Nitric oxide (NO) has been identified as the powerful endothelium-derived relaxing factor (EDRF). Although inhaled NO decreases PVR,it has no or little effect on SVR.Following approval of the IRB,29 mongrel dogs were used for animal models to validate the efficacy of inhaled NO on the cardiac performance following XU after XC.The dogs were anesthetized with pentobarbital, intubated and mechanically ventilated. Systemic arterial pressure was monitored via a brachial and femoral arterial cannula. Th … More e pulmonary artery catheter was advanced to the main pulmonary artery, cardiac output was measured with thermodilution technique. Anesthesia was maintained with fentanyl, midazoram and inhalation of fifty percent nitrous oxide in oxygen. After thoracotomy, descending aorta was exposed for cross-clamping at just above the diaphragm.In all dogs, descending aorta was cross-clamped for thirty minutes and was unclamped. Anesthetized dogs (n=29) were divided into four groups with respect to the treatment before XU.In seven dogs (Group1), descending aorta was simply unclamped without any treatment. Dogs in group 2 were given extra-volume loading of lactated Ringer's solution before XD.Dogs in group 3 inhaled NO in a concentration of 20 ppm from just after XD to the end of the study. Dogs in group 4 were treated with inhalation of NO at 40ppm from XD.Hemodynamic variables were recorded at the following six time-points : just before XC (pre-XC), just before XU (pre-XU), 5 min after XU (5 min), 15 min after XU (15 min), 30 min after XU (30 min), and 60 min after XU (60 min).Although in group 1,2 and 3, mean pulmonary arterial pressure (MPAP) significantly increased at 5 min, MPAP did not significantly increase in group 4 compared with the value of pre XU.At 15 min, although the values in MPAP were restored in group 1,3 and 4, the value in group 2 was not restored. The values in mean arterial pressure, central venous pressure, pulmonary arterial wedge pressure, heart rate and cardiac output did not show significant changes throughout the study protocol. Peak velocities of early diastolic flow wave in transmitral flow assessed by transesophageal pulsed Doppler echocardiography decreased at 5 min in group 1 and 3.These results indicate that volume loading before XU may not always prevent post-XU hypotension, and that may have adverse effect on pulmonary hypertension. Although inhalation of NO at 20 ppm may not prevent pulmonary hypertension following XU,inhalation at 40 ppm would prevent pulmonary hypertension without a fall in MAP. Less

众所周知，腹主动脉切除术（AAA切除术）中，主动脉阻断（XC）和开放（XU）后可发生血液动力学的突然变化。一些报告表明XU引起肺动脉压显著升高。AAA切除术期间血流动力学管理的基本原理存在争议。血管扩张剂不仅能降低肺血管阻力（PVR），还能降低全身血管阻力（SVR），导致动脉压下降。一氧化氮（NO）是一种强有力的内皮源性舒张因子（EDRF）。吸入NO虽然可以降低PVR，但对SVR没有影响或影响很小。经伦理委员会批准，我们使用29只杂种犬作为动物模型，验证吸入NO对XC后XU心脏功能的有效性。狗用戊巴比妥麻醉，插管并机械通气。通过肱动脉和股动脉插管监测全身动脉压。日 ...更多信息 将肺动脉导管插入主肺动脉，用热稀释法测定心输出量。麻醉维持芬太尼，咪达唑仑和吸入百分之五十的一氧化二氮的氧气。开胸后，暴露降主动脉，于膈肌上方交叉夹闭，所有犬均交叉夹闭降主动脉30 min后松开。将29只麻醉犬随机分为4组，其中7只（组1）仅开放降主动脉，不作任何处理。第2组在XD前给予乳酸林格氏液超容量负荷，第3组在XD后即刻至实验结束吸入浓度为20ppm的NO。第4组犬吸入40ppm的XD NO，在以下6个时间点记录血流动力学参数：XC前、XU前、XU后5 min、XU后15 min、XU后30 min、XU后60 min。肺动脉平均压（MPAP）在5min时明显升高，第4组MPAP与术前相比无明显升高，第1、3、4组MPAP在15min时恢复，第2组MPAP未恢复。在整个研究方案中，平均动脉压、中心静脉压、肺动脉楔压、心率和心输出量的值未显示出显著变化。经食管脉冲多普勒超声心动图显示，第1组和第3组二尖瓣口舒张早期血流峰值速度在5min时降低。结果提示，术前容量负荷并不一定能预防术后低血压的发生，可能对肺动脉高压有不良影响。虽然吸入20 ppm的NO可能不能预防XU后的肺动脉高压，但吸入40 ppm的NO可以预防肺动脉高压而不会降低MAP。少

项目成果

赤松 繁: "超音波ドプラ法による絶対流速測定法と連続的心拍出量測定法への応用" 循環制御. 19(印刷中). (1998)

Shigeru Akamatsu：“使用超声多普勒方法的绝对流速测量方法及其在连续心输出量测量方法中的应用”19（出版中）。

Ueda N,Akamatsu S,Dohi S,Hamaya Y,Terazawa E,Shimonaka H,Ohata H: "Pulmonary Arterial and Right Ventricular Responses to Prophylactic Volume Loading before Aortic Unclamping during Abdominal Aortic Aneurysmectomy" Anesth Analg. (submitted).

Ueda N，Akamatsu S，Dohi S，Hamaya Y，Terazawa E，Shimonaka H，Ohata H：“腹主动脉瘤切除术期间主动脉松开前肺动脉和右心室对预防性容量负荷的反应”麻醉模拟。

Norio Ueda: "Pulmonary arterial and right venticular responses to prophylactic rolume loading before aortic unclamping during abdominal aortic aneurysmectomy" Anesth & Analy. (発表予定).

Norio Ueda：“腹主动脉瘤切除术中主动脉松开前肺动脉和右心室对预防性心室负荷的反应”Anesth & Analy（待提交）。

上田宣夫: "心機能低下患者の麻酔・手術中管理" 麻酔. 45・増. S114-S121 (1996)

Nobuo Ueda：“心脏功能下降患者的麻醉和术中管理”Anesthesia 45，En。

Akamatsu S,Kondo Y,Dohi S: "Velocity measurement using a newly developed Doppler catheter indipendent of angle of incidence" Circ Cont. 17. 379-385 (1996)

Akamatsu S、Kondo Y、Dohi S：“使用新开发的多普勒导管进行速度测量，与入射角无关” Circ Cont。