吸入麻醉药对心肌功能的影响
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摘要
目的：研究建立吸入麻醉下电击引颤法的方法学。方法：雄性新西兰白兔42只，体重2～2.5kg，在安氟醚麻醉下，经胸电击刺激心脏，每次电击时间30秒，电击间隔时间15分钟。第一步6只白兔，在1MAC麻醉下，不同电压电击，依次为10、15、20、25、30、35V。第二步30只白兔，在不同麻醉药浓度下(1.0，1.5，2.0，2.5和3.0MAC)，以相同电压电击。第三步6只白兔，同一吸入麻醉药浓度，同一电压电击心脏。结果：第一步确定了亚致颤电压25V；第二步随麻醉药浓度的增加，亚致颤电压刺激心脏可诱发室颤的机率增加；第三步在1MAC麻醉下，亚致颤电压连续电击心脏，不能诱发室颤。结论：亚致颤电压对心脏的直接损伤小，可用于衰竭心脏诱颤，比较吸入麻醉药对心脏的毒性强度。
Objective: To Creation a methodology on evoking ventricular fibrillation by electric shock. Methods: Male New Zealand white rabbit 42, weight range 2~2.5kg were chosed. The experiment include three parts: The first steps: 6 rabbits were gave electric shock with 10, 15, 20, 25, 30, 35V under 1 MAC anesthesia. The second step: 30 rabbits were gave electric shock with the subthreshold of evoking ventricular fibrillation under different concentration of volatile anesthetics. The third step: 6 rabbits were gaven electric shock 6 times with the subthreshold under 1MAC anesthesia. Result: Subthreshold of evoking ventricular fibrillation is 25V; The subthreshold of evoking ventricular fibrillation is easier to evoke vetricular fibrillation by increasing the concentration of volatile anesthetics, and the subthreshold did not damage heart by increasing times of electric shock under 1MAC aneshtetics. Conclusion: Subthreshold of electric shocks (25V) have little damage on heart and have high sensibitity to find the response of heart to change of anesthetic concentration.
Objective: To Creation a methodology on evoking ventricular fibrillation by electric shock. Methods: Male New Zealand white rabbit 42, weight range 2~2.5kg were chosed. The experiment include three parts: The first steps: 6 rabbits were gave electric shock with 10, 15, 20, 25, 30, 35V under 1 MAC anesthesia. The second step: 30 rabbits were gave electric shock with the subthreshold of evoking ventricular fibrillation under different concentration of volatile anesthetics. The third step: 6 rabbits were gaven electric shock 6 times with the subthreshold under 1MAC anesthesia. Result: Subthreshold of evoking ventricular fibrillation is 25V; The subthreshold of evoking ventricular fibrillation is easier to evoke vetricular fibrillation by increasing the concentration of volatile anesthetics, and the subthreshold did not damage heart by increasing times of electric shock under 1MAC aneshtetics. Conclusion: Subthreshold of electric shocks (25V) have little damage on heart and have high sensibitity to find the response of heart to change of anesthetic concentration.
引文
1 Wolfson B, Keilar CM, Lake CL, et al: Anesthetic index-A new approach. Anesthesiology, 1973, 38: 583
2 Kissin I, Morgan PL, Smith LR, et al: Comparison of isoflurane and halothane safety margins in rats. Anesthesiology, 1983, 58: 556
3 Eger EI, Saidman LJ, Brandstater B: Minimum alveolar anesthetic concentration: A standard of anesthetic potency. Anesthesiology, 1965, 26: 756
1. Sato S, Vanini V, Sands ME The use of forane anesthesia for surface-induced deep hypothermia Ann Thorac Surg, 1975, 29:299-307
2. Atlee TL, Bosnjiak ZJ. Mechanisms for cardiac dysrhythmia anesthesia. Anesthesiology, 1990, 72:347
3. Eger EI Ⅱ, Saidman LJ, Brandstater B. Minimum alveolar anesthetic concentration: a standard of anesthetic potency. Anesthesiology, 1965, 26: 756
4．周伟，晏馥霞，刘进．电击引颤法在吸入麻醉药研究中应用．中华麻醉学杂志，1997，17：296
5. Regan M J, Eger EI Ⅱ. Effect of hypothermia in dogs on anesthetizing and apneicdoses of inhalation agents. Determination of the reanesthetic index(apnea/MAC) Anesthesiology, 1967, 28, 689
6. Wolfson B, Keilar CM, Lack CL, et al. Anesthetic index: A new approch Anesthesiology, 1973, 38:583
7. Vitez TS, White PF, Eger EI Ⅱ. Effects of hypothermia on halothane MAC and isoflurane MAC in the rat. Anesthesiology, 1974, 40:52
8. Ming-Zheng Liu, Xiao-Qin Ho, Jin Liu. The effects of hypothermia on isoflurane MAC in children. Anesthesiology, 2001; 94:429
9．周健新，刘进：吸入麻醉药分配系数的系列研究．中国协和医科大学研究生论文，1999，10：97
10. Pavlin EG, Su JY. Cardiopulmonary pharmcology. In Miller RD. Anesthesia. 4th edn. New York: Churchill Livingstone, 1993, 12511. Wolfson B, Hetrick WD, Lake CL, et al. Anesthetic indices further data, Anesthesiology, 1978,48: 187
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13. Mutoh T. Volatile anesthetics suppress cardiac function in man; an investigation based on systolic time intervals. Masui, 1993, 42: 83
14. Graf BM, Vicenzi MN, Bosnjak ZJ, et al: The comparative effects of equimolar sevoflurane and isoflurane in isolated hearts. Anesth Analg, 1995, 81:1026
1 张伯强，刘进．国产和进口安氟醚的大鼠MAC和LD_(50)比较．中华麻醉学杂志，1997，17：490-1
2 Causins MJ, Greenstein LR, Hitt BA. Metabolism and renal effects of enflurane in man. Anesthesiology, 1976,44-53
3 Mazze RI, Sievenpiper TS. Renal effects of enflurene and halothane in patients with abnormal renal fuction. Anesthesiology, 1984, 60:161-3
4 刘进，胡小琴，高静华，等 心内直视手术时氟化吸入麻醉药对肾功能的影响。中华麻醉学杂志，1989，9：1561. Freedman BM, Hamm DP, Everson CT, et al: Enflurane enhances postischemic functional recovery in the isolated rat heart. Anesthesiology 1985; 62: 29
2. Lochner A, Harper IS, Salie R, et al: Halothane protects the isolated myocardium against excessive total intracellular calcium and structural damage during ischemia and reperfusion. Anesth Analg 1994; 79: 226
3. Cope DK, Impastato WK, Cohen MV, et al: Volatile aneshtetics protect the rabbit myocardium from infarction. Anesthesiology. 1997; 86: 699
4. Kersten JR., Orth KG, Pagel PS, et al: Role of adenosine in isoflurane-induced cardioprotection. Anesthesiology 1997; 86: 1128-39
5. Perrault LP, Menasche P: Preconditioning: can nature's shield be raised against surgical ischemic-reperfusion injury? Ann Thorac Surg 1999; 68:1988-1994
6. Belhomme D.,Peynet J.,Louzy M.,et al: Evidence for preconditioning by isoflurane in coronary bypass surgery. Circulation 1999; 100(suppl Ⅱ): Ⅱ 340
7. Preckel B, Schlack W, Thamer V: Enflurane and isoflurane, but not halothane, protect against myocardial reperfusion injury after cardioplegic arrest with HTK solution in the isolated rat heart. Anesth Analg 1998; 87(6): 1221-7
8. Brasil LA, Gomes WJ, Salomao R, et al: Inflammatory response aftermyocardial revascularization with or without cardiopulmonary bypass. Ann Thorac Surg 1998,66: 56
9. Heindl B, Becker BF, Conzen P: Halothane, sevoflurane and isoflurane reduce adhesion of blood platelets under low-flow conditions in the coronary system of isolated guinea pig hearts. Acta Anaesthesiol Scand 1998,42:995-1003
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2 Kissin I, Morgan PL, Smith LR, et al: Comparison of isoflurane and halothane safety margins in rats. Anesthesiology, 1983, 58: 556
3 Eger EI, Saidman LJ, Brandstater B: Minimum alveolar anesthetic concentration: A standard of anesthetic potency. Anesthesiology, 1965, 26: 756
1. Sato S, Vanini V, Sands ME The use of forane anesthesia for surface-induced deep hypothermia Ann Thorac Surg, 1975, 29:299-307
2. Atlee TL, Bosnjiak ZJ. Mechanisms for cardiac dysrhythmia anesthesia. Anesthesiology, 1990, 72:347
3. Eger EI Ⅱ, Saidman LJ, Brandstater B. Minimum alveolar anesthetic concentration: a standard of anesthetic potency. Anesthesiology, 1965, 26: 756
4．周伟，晏馥霞，刘进．电击引颤法在吸入麻醉药研究中应用．中华麻醉学杂志，1997，17：296
5. Regan M J, Eger EI Ⅱ. Effect of hypothermia in dogs on anesthetizing and apneicdoses of inhalation agents. Determination of the reanesthetic index(apnea/MAC) Anesthesiology, 1967, 28, 689
6. Wolfson B, Keilar CM, Lack CL, et al. Anesthetic index: A new approch Anesthesiology, 1973, 38:583
7. Vitez TS, White PF, Eger EI Ⅱ. Effects of hypothermia on halothane MAC and isoflurane MAC in the rat. Anesthesiology, 1974, 40:52
8. Ming-Zheng Liu, Xiao-Qin Ho, Jin Liu. The effects of hypothermia on isoflurane MAC in children. Anesthesiology, 2001; 94:429
9．周健新，刘进：吸入麻醉药分配系数的系列研究．中国协和医科大学研究生论文，1999，10：97
10. Pavlin EG, Su JY. Cardiopulmonary pharmcology. In Miller RD. Anesthesia. 4th edn. New York: Churchill Livingstone, 1993, 12511. Wolfson B, Hetrick WD, Lake CL, et al. Anesthetic indices further data, Anesthesiology, 1978,48: 187
12. Sahlman L, Henriksson BA, Martner J, et al: Effects of halothane, enflurane,and isoflurane on Coronary vascular tone, Myocardial performance, and oxygen consumption during controlled changes in aortic and left atrial pressure. Anesthesiology, 1988, 69: 1
13. Mutoh T. Volatile anesthetics suppress cardiac function in man; an investigation based on systolic time intervals. Masui, 1993, 42: 83
14. Graf BM, Vicenzi MN, Bosnjak ZJ, et al: The comparative effects of equimolar sevoflurane and isoflurane in isolated hearts. Anesth Analg, 1995, 81:1026
1 张伯强，刘进．国产和进口安氟醚的大鼠MAC和LD_(50)比较．中华麻醉学杂志，1997，17：490-1
2 Causins MJ, Greenstein LR, Hitt BA. Metabolism and renal effects of enflurane in man. Anesthesiology, 1976,44-53
3 Mazze RI, Sievenpiper TS. Renal effects of enflurene and halothane in patients with abnormal renal fuction. Anesthesiology, 1984, 60:161-3
4 刘进，胡小琴，高静华，等 心内直视手术时氟化吸入麻醉药对肾功能的影响。中华麻醉学杂志，1989，9：1561. Freedman BM, Hamm DP, Everson CT, et al: Enflurane enhances postischemic functional recovery in the isolated rat heart. Anesthesiology 1985; 62: 29
2. Lochner A, Harper IS, Salie R, et al: Halothane protects the isolated myocardium against excessive total intracellular calcium and structural damage during ischemia and reperfusion. Anesth Analg 1994; 79: 226
3. Cope DK, Impastato WK, Cohen MV, et al: Volatile aneshtetics protect the rabbit myocardium from infarction. Anesthesiology. 1997; 86: 699
4. Kersten JR., Orth KG, Pagel PS, et al: Role of adenosine in isoflurane-induced cardioprotection. Anesthesiology 1997; 86: 1128-39
5. Perrault LP, Menasche P: Preconditioning: can nature's shield be raised against surgical ischemic-reperfusion injury? Ann Thorac Surg 1999; 68:1988-1994
6. Belhomme D.,Peynet J.,Louzy M.,et al: Evidence for preconditioning by isoflurane in coronary bypass surgery. Circulation 1999; 100(suppl Ⅱ): Ⅱ 340
7. Preckel B, Schlack W, Thamer V: Enflurane and isoflurane, but not halothane, protect against myocardial reperfusion injury after cardioplegic arrest with HTK solution in the isolated rat heart. Anesth Analg 1998; 87(6): 1221-7
8. Brasil LA, Gomes WJ, Salomao R, et al: Inflammatory response aftermyocardial revascularization with or without cardiopulmonary bypass. Ann Thorac Surg 1998,66: 56
9. Heindl B, Becker BF, Conzen P: Halothane, sevoflurane and isoflurane reduce adhesion of blood platelets under low-flow conditions in the coronary system of isolated guinea pig hearts. Acta Anaesthesiol Scand 1998,42:995-1003
10. Beyne P, Lagneau F, Letteron P, et al: Les produits de remplissage vasculaire interferent dans le dosage sanguin de la troponine I. Ann Fr Anesth Reanim, 1997; 16: R 134
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