Japanese
Title僧帽弁置換術(MVR)施行患者の術前服用薬と麻酔中の血中カテコラミン濃度(pCA)の推移とその評価
Subtitle原著
Authors白井希明*, 横川すみれ*, 松本克平*, 西山圭子*, 福岡靖介*, 高橋薫*, 近藤泉*, 小泉博子*, 野村実*, 藤田昌雄*
Authors(kana)
Organization*東京女子医科大学麻酔学教室
Journal循環制御
Volume12
Number1
Page85-92
Year/Month1991/
Article原著
Publisher日本循環制御医学会
Abstract「要旨」僧房弁置換術の麻酔中の血中カテコラミン濃度(pCA)推移より, 患者の服用薬の効果を検索した. 対象症例52例, 平均年齢は49.12才平均体重は52.70kgであった. 服用薬を作用の違いによって4群に分類した. 麻酔法はFentany+Diazepam+O2(orAIR)+Pancuroniumである. 各パラメーターは麻酔前(S0), 気管内挿管後(S1), 皮膚切開後(S2), 胸骨切開後(S3)の4点で採取した. S0をコントロールとして経時的に統計比較検討を行なった. pCAの検出は液体高速クロマトグラフィー法でおこなった. 全症例で利尿剤を服用していた. digitalis, 血管拡張薬, 抗不整脈剤3剤服用群でS0において他の群に比較してpCAは高い濃度を示していた. pCAの中で血中ドパミンの推移は多薬剤服用群ほど検出率が低下する注目すべき所見を認めた. またこの傾向は麻酔, 外科的ストレスの影響を殆ど受けず維持されていた. しかし, 使用麻酔薬の量および血行動態にも各群間で統計的に有意差は認めなかった. これは薬剤の治療効果が交感神経緊張のバランスに微妙な影響を与えていることが示唆され, また, 術前の血行動態で肺動脈圧(mPAP)とpCAとの関係を見ると, 血中エピネフリン濃度との関係が高い所見が認められた. 服用薬剤の血中濃度及び代謝経路における活性・不活性とpCAの関係の検索は麻酔薬との相乗効果も含めて薬理学的にも有用であると考えられる.
Practice基礎医学・関連科学
Keywordsmitral valve disease, drugs therapy, plasma catecholamine, fentanyl anesthesia
English
TitleEffects of Drug Therapy on Plasma Catecholamine Levels During Fentanyl-Anesthesia for Mitral Valve Replacemant (MVR).
Subtitle
AuthorsK.Shirai, S.Yokokawa, K.Matsumoto, K.Nishiyama, S.Fukuoka, K.Takahashi, I.Kondo, H.Koizumi, M.Nomura, M.Fujita
Authors(kana)
OrganizationDepartment of Anesthesiology Tokyo Women's Medical College
JournalCirculation Control
Volume12
Number1
Page85-92
Year/Month1991/
ArticleOriginal article
PublisherJapan Society of Circulation Control
AbstractThe present study was designed to evaluate the effects of drugs which been used preoperatively on plasma catechoalamine levels (pCA) during anesthesia. The drugs were mainly digitalis, vasodilators, and calcium antagonist, which were used for improvement of cardiac function and prevention of CHF. We evaluated the relations between the hemodynamic changes and the changes in pCA by these drugs during fentanyl anesthesia. Effects on the sympathetic nerve system of these drugs were evaluated by measurements of pCA (pNE, pE, pDA) during anesthesia with fentanyl-diazepam-O2 or air. Plasma catecholamine levels were measured by high performance liquid chromatography before anesthesia (S0), after intubation (S1), after skin incision (S2), and sternotomy (S3). At same time, hemodynamic parameters were measured. Fifty-two patients were diveded into 4 groups by kind of drugs. Patient given digitalis (D) only were 27 (D-1), D plus vasidilators (V) were 12 (D-2), D, V plus antiarrhythmics (A) were 6 (D-3) and D plus V were 6 (D-4). Results of these data were statistically analyzed by Fisher' test and p<0.05, or p<0.001 was considered significant. In catecholamine levels at S0, pNE and pE in D-3 were higher than those of other groups, whereas the pDA in D-1 showed high levels at S2 and S3. The pDA in D-2, D-3 and D-4 recieving vasodilators was low under sugical stress. It was characteristic in D-2 and D-3 that the pDA levels were diminishied at S2 and S3. These results suggest that vasodilators will effects on reduction of Plasma dopamine level. Effects of vasodilators on sympathetic nerve tone should be remarked. These levels were nearly kept on preanesthesia levels during anesthesia. A gradual increase in plasma catecholamines was observed in patients receiving may kind of drugs. It was considered that simultaneously measurement of drugs coneentration in blood and changes of pCA levels.
PracticeBasic medicine
Keywordsmitral valve disease, drugs therapy, plasma catecholamine, fentanyl anesthesia

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