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| 題 名 | The Hemodynamic Effects of Atracurium during High-Dose Fentanyl Anesthesia for Aortocoronary Bypass Operation=大量成癮性止痛麻醉劑施用於冠狀動脈血管繞道手術時Atracurium對血流動力之影響 |
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| 作 者 | 黃芳彥; 陳楷模; 陳大樑; | 書刊名 | 中華民國外科醫學會雜誌 |
| 卷 期 | 19:2 1986.05[民75.05] |
| 頁 次 | 頁83-88 |
| 分類號 | 416.5 |
| 關鍵詞 | 大量成癮性止痛麻醉劑; 冠狀動脈血管繞道手術; 血流動力; Atracurium; |
| 語 文 | 英文(English) |
| 中文摘要 | 從1985年6月到1985年12月之間,選取20位冠狀動脈阻塞的病人,接受大動脈一冠狀動脈血管植接術,並以高劑量成癮性麻醉劑Fentanyl合併新肌肉鬆弛劑Atracurium進行麻醉,觀察其對這些病人之血行動力學方面之影響。病人平均年齡為58±3.9歲,平均體重為61.3±4.1公斤,一般健康狀況為ASA分類II至III之間。病人先接受75 μg/kg的Fentanyl做為麻醉誘導,待血壓、心跳穩定後,給予肌肉鬆弛劑Atracurium 0.6 mg/kg,並分別於2、5、10分鐘後觀察其血壓、心跳、平均動脈壓、中央靜脈壓、肺微血管楔壓、心輸出量及全身血管阻力等予以記錄之,並與注射前之數值比較。 由於使用傳統之非去極化肌肉鬆弛劑,有其極限及缺點。如Tubocurarine會降低血壓,並有組織胺之釋放,而Pancuronium則會升高血壓及心跳,增加心肌耗氧量。故近年來,麻醉學家嘗試尋求一新肌肉鬆弛劑,以求其對於心臟血管及血行動力學方面盡量穩定,以對心肌功能不好之病人(如冠狀動脈疾病病人),進行安全麻醉。實驗結果,病人接受75 μg/kg的Fentanyl,加上0.6 mg/kg的Atracurium之後,心跳、平均動脈腫、中央靜脈壓、肺微血管積壓,均無明顯改變。而全身血管阻力於5分鐘及10分鐘後稍呈降低(p<0.05),心輸出量方面,則於10分鐘後,稍為增加(p<0.05)。 由此可知,對於心肌功能不良之病人,Atracurium為一理想之肌肉鬆弛劑,它不但對心臟影響不大,而且合併Fentanyl使用時,可以降低全身血管阻力,而達到滅少心肌耗氧量之目的。 |
| 英文摘要 | Twenty patients with coronary artery diseases were scheduled for aortocoronary bypass surgery. The mean age was 58±3.9 years old and the average body weight was 61.3±4.1 Kg. All of them were classified as ASA status II to III. High-dose fentanyl (75 μg/kg) was applied as the induction agent. In order to study the hemodynamic responses of atracurium, a new non-depolarization muscle relaxant recently available in Taiwan, it dose was set at 0.6 mg/kg. The cardiovascular changes were monitored by precordial electrocardiogram, radial artery line and Swan-Ganz catheter via right internal jugular vein. Heart rate (HR), mean arterial pressure (MAP), central venous pressure (CVP), pulmonary capillary wedge pressure (PCWP), cardiac output (CO) and systemic vascular resistance (SVR) were collected and calculated before and 2, 5, 10 minutes after atracurium was given. The SVR decreased significantly from 1476±418 dyne.sec.cm-5 to 1237±384 dyne.sec.cm-5 and 1266±490 dyne.sec.cm-5 at 5 and 10 minutes respectively (P<0.05). Cardiac output increased from 3.29±0.51 L.min-1 to 3.87±0.36 L.min-1 (P<0.05). The other parameters such as HR, MAP, CVP and PCWP showed no significant changes. Used concurrently with high-dose fentanyl, atracurium offered a relatively stable hemodynamic baseline for the patient with compromised myocardial reserve. Moreover, myocardial oxygen consumption decreased due to lowered afterload. Atracurium appears to be rather beneficial and safe for the patients with coronary lesions. |
本系統中英文摘要資訊取自各篇刊載內容。