| Japanese |
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| Title | 小児開心術中における血管作動薬の使用法 |
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| Subtitle | 特集 |
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| Authors | 堀本洋*, 富江久*, 半澤浩一*, 成田友代* |
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| Authors(kana) | |
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| Organization | *静岡県立こども病院麻酔科 |
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| Journal | 循環制御 |
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| Volume | 12 |
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| Number | 4 |
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| Page | 625-631 |
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| Year/Month | 1991/ |
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| Article | 報告 |
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| Publisher | 日本循環制御医学会 |
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| Abstract | 「要旨」最近6年間の静岡県立こども病院でおこなわれた開心術中に使用された血管作動薬についてretrospectiveに検討してみた. カテコラミンは全症例の70%に, DOA, ISP, DOBの順で用いられていた. カテコラミン大量使用例ではDOAとDOBの1：1混合型を用いた. DOAには肺血管抵抗上昇作用があるため, 小児に多い肺血流増多症例での使用は注意を要し, 心室筋のコンプライアンスの低い小児では心拍出量の維持にはISPが最も有効だと考える. 血管拡張薬は97%とほとんどの症例に用いられ, SNPとTNGが使用され, これが好成績の大きな原因となっているものと確信している. 現在は肺, 体血管抵抗両方とも減少できるTNGを多用するようになっている. 「はじめに」心術期に血管作動薬を使用する際に, 薬理学的基礎知識を基に薬の種類, 投与量を決めてゆくのは当然である. しかしそれらの組み合わせは無限に近くあり, その中でどのような使い方をしてゆくかは, 麻酔科だけではなく, 一緒に仕事をしている心臓外科医との合意で, またこれまでの臨床経験から決まってくるものなので, それらは各施設毎に違うのは当然である. |
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| Practice | 基礎医学・関連科学 |
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| Keywords | catecholamines, nitroglycerine, afterload reduction, pulmonary vasodilators, pulmonary hypertensive crisis |
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| English |
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| Title | Intraoperative use of vasoactive drugs for pediatric open heart surgery |
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| Subtitle | |
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| Authors | Yoh Horimoto, Hisashi Tomie, Koichi Hanzawa, Tomoyo Narita |
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| Authors(kana) | |
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| Organization | Department of Anesthesia Shizuoka Children's Hospital |
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| Journal | Circulation Control |
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| Volume | 12 |
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| Number | 4 |
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| Page | 625-631 |
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| Year/Month | 1991/ |
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| Article | Report |
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| Publisher | Japan Society of Circulation Control |
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| Abstract | The clinical use of vasoactive drugs during pediatric open heart surgery in this 6 years at Shizuoka Children's Hospital was reviewed retrospectively. Catecholamines were administered for 70% of total patients who succeeded to wean from cardiopulmonary bypass. Dopamine was used most frequently, followed by isoproterenol and dobutamine. In seventy-six percent out of the cases of whom required high dose of catecholamines, dopamine and dobutamine were administered concomitantly to avoid its alpha receptors stimulating effect if used indivisually in high dose. The ratio was 1：1 in all cases. Dopamine, however, has to be used cautiously to the patients with pulmonary hypertension because of its intrinsic action of increasing pulmonary resistance. Isoproterenol was recommended for pediatric patients to induce tachycardia, to compensate their low compliant ventricular muscles. Systemic vasodilators were used in 97% of total open heart surgery. Although two mainly used drugs were sodium nitroprusside and nitroglycerin in this period, nitroglycerin is now used most frequently as an afterload reducer to both ventricules. |
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| Practice | Basic medicine |
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| Keywords | catecholamines, nitroglycerine, afterload reduction, pulmonary vasodilators, pulmonary hypertensive crisis |
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