| Japanese |
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| Title | 人工心肺中灌流圧上昇時のアムリノンの効果 |
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| Subtitle | 症例 |
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| Authors | 堀本洋, 黒嵜明子, 水村郁, 宝積健, 小幡良次 |
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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 | 18 |
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| Number | 3 |
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| Page | 414-417 |
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| Year/Month | 1997/ |
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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」主な麻酔薬をフェンタニールとした10例の先天性心疾患根治術症例の人工心肺中灌流圧の上昇に際し, 血管拡張作用と心筋収縮力増強作用とを持つアムリノン1mg/kgのボーラス投与の後10μg/kg/minの持続投与を行った. 灌流圧は投与前値の平均65%に低下し, その後適正なレベルを維持することができた. アムリノンを人工心肺中の灌流圧上昇時に使用し, 確実で安定した効果が得られた. 「はじめに」人工心肺からの送血量が一定の状況下での血圧上昇は体血管抵抗の上昇を意味する. 体血管抵抗の上昇が続けば人工心肺からの離脱時には心臓の後負荷を増大させ, 不全心の仕事量を, 結果的には心筋酸素消費量を増大させる危険性がある. 著者らは小児の心臓開心手術後においては後負荷減少療法は必須なものと考えてきた. したがって, 人工心肺中に灌流圧が増大した時には灌流量を減少させるのではなくクロールプロマジンの適宜投与によって灌流圧を低下させていた. |
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| Practice | 基礎医学・関連科学 |
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| Keywords | Amrinone, Cardiopulmonary bypass, Perfusion pressure, Afterload reduction, Pediatric anesthesia |
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| English |
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| Title | Amrinone Controls Perfusion Pressure during Cardio-pulmonary Bypass in Infants and Children. |
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| Subtitle | |
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| Authors | Yoh Horimoto, Akiko Kurosaki, Kaoru Mizumura, Ken Hozumi, Ryohji Obata |
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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 | 18 |
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| Number | 3 |
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| Page | 414-417 |
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| Year/Month | 1997/ |
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| Article | Report |
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| Publisher | Japan Society of Circulation Control |
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| Abstract | Cardiopulmonary bypass causes severe stress to patients, especially children, who undergo open heart surgery. This stress may release various vasoactive substances during the bypass period including catecholamines, asopressin, thromboxane, angiotensin II and others, resulting in an increase of perfusion pressure. This phenomenon, under the constant flow with a roller pump, causes an increase of systemic vascular resistance, which forces the heart to work much harder after weaning from cardiopulmonary bypass. The elevation of perfusion pressure should be avoided to optimize the postoperative course. We have adopted amrinone, which is known to have both vasodilative and positive inotropic effects. Although intermittent administration of chlorpromazine has been used for control of perfusion pressure hitherto, amrinone as a 1mg/kg intravenous bolus, followed by continuous intravenous administration at the rate of 10μg/kg/min was able to control perfusion pressure to the desired level without any vasoactive drugs for restoration of pressure during this period. We concluded that amrinone is suitable for optimal control of perfusion pressure during cardiopulmonary bypass in infants and children. |
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| Practice | Basic medicine |
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| Keywords | Amrinone, Cardiopulmonary bypass, Perfusion pressure, Afterload reduction, Pediatric anesthesia |
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