Japanese
Title心血管手術麻酔におけるDobutamineの効果 -統計学的検索と臨床の接点-
Subtitle原著
Authors白井希明*, 西山圭子*, 松本克平*, 横川すみれ*, 福岡靖介*, 高田勝美*, 勝田昌雄*
Authors(kana)
Organization*東京女子医科大学麻酔学教室
Journal循環制御
Volume11
Number3
Page359-365
Year/Month1990/
Article原著
Publisher日本循環制御医学会
Abstract「要旨」心血管手術の麻酔中の血行動態維持にカテコラミンは欠かせないものである. 各種のカテコラミンの効果は結果のみでその有効性が評価される傾向が強い. 本研究は有効性の背景因子を麻酔記録およびその他に記載された情報を統計学的に検索し臨床上の接点について考察した. 対象はDOBが使用された149例(男：82, 女：67)で, 年令は2月から78才(平均：46.0)である. 解析に使用した要因は背景因子が5項目, 病態因子が9項目, 血液因子が12項目, 血行動態因子が14目, 手術因子は4項目, そして治療因子の3項目である. 血行動態因子は麻酔導入前と後, 体外循環開始(CPB ; cardiopulmonary bypass)15分後, CPB終了前15分, CPB終了後15, 30, 60, 90, 120分時点である. これらから麻酔中の全経過より主治医判定として著効・有効・無効の3段階に判定分類した. これは奇異性が高くなる危険性があるが統計学的に判定されると考えた. 治療効果に及ぼす因子の評価は投与患者の病態因子の治療効果に与える影響を項目毎に評価した. 同時に連続的に測定されている項目の評価には, その項目を説明変数, 主治医綜合判定効果を応答変数とするロジステック回帰解析を適応した. DOBを代表とするカテコラミンの有効性の背景には術前の血行動態の評価, そして麻酔および体外循環中に使用された塩酸モルヒネその有効性に最も寄与していることが判明した. DOBは末梢血管床の極端な緊張下ではその有効性は期待出来ないことが示唆された. DOBなどのカテコラミンの効果は交換神経の緊張に与える諸因子とそのバランスが重要な条件であると言える.
Practice基礎医学・関連科学
Keywords
English
TitleEffects of dobutamine (DOB) during cardiovascular anesthesia：Stastical analysis and clinical considerations
Subtitle
AuthorsKimei Shirai, Keiko Nishiyama, Kappei Matsumoto, Sumire Yokokawa, Seisuke Fukuoka, Katsumi Takada, Masao Fujita
Authors(kana)
OrganizationDepartment of Anesthresia Tokyo Women's Medical Callege
JournalCirculation Control
Volume11
Number3
Page359-365
Year/Month1990/
ArticleOriginal article
PublisherJapan Society of Circulation Control
AbstractCatecholamines are necessary for control of hemodynamics during anesthesia in cardiovascular surgery. The effects of various catecholamines tend to be evaluated only from results or impression. In the present study, the recorded data in the anesthesia chart and other parameters were analyzed statistically and background factors of effects, and clinical points were considered. The patients were 149 (82 males and 67 females) ranging in age from 2 months to 78 years (average 46) who were administrated DOB during anesthesia. The factors used in the analysis consisted of five background ; 9 pathological factors, 14 hemodynamic factors, 4 operative factors, 14 hematological factors, and 3 therapeutic factors. The hemodynamic parameters were measured before and after induction of anesthesia, after 15 minutes of begining cardiopulmonary bypass (CPB), 15 minutes before the end of CPB, and 15, 30, 45, 60, 90, 120 mi’nutes after the end of CPB. The evaluation by pyhsician charge was into three grades：excellent, good and poor, from the overa11 course during anesthesia based on these measurements. The factors related to therapeutic effects were each evaluated by the effects of the treatment on the pathological of factors in the patients administered DOB. In the evaluated factors measured continuously as same time, logical regression analysis using these factors as explanatory variables and the results of the evaluation by the physician in charge as response variable applied. lt was clear that the evaluation of preoperation hemodynamics, the Hcl-morphine used during anesthesia, and CPB are the important factor which contribute most to the effects of catecholamnes such as DOB. It was suggested that the effects of DOB cannot be anticipated under conditions of high degree vasoconstriction. These results mean that the balance of sympathetic tone is an important factors in the effects of catecholamines during anesthesia.
PracticeBasic medicine
Keywords

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