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篇名
Propofol對離體兔子心臟的直接作用
並列篇名
The Direct Cardiac Effect of Propofol on Intact Isolated Rabbit Heart
作者 陳威豪李昭然洪國全葉富欽曾稼志蕭介民
中文摘要
背景:Propofol在臨床使用日漸普及,但其低血壓作用仍是令人擔心的問題;近年來雖然已有多篇論文探討Propofol低血壓之機制,可能機制包括周邊阻力與心收縮力的抑制;但活體研究通常不易控制其他因子,如前負荷與血管阻力,甚至於可能受神經或賀爾蒙等影響致無法完全獨立探討;而離體模式則大部分以細胞為單位;目前已完整離體心臟模式Propofol濃度對心收縮力之影響之報告仍少。本研究以兔子的完整離體心臟模式(modified Langendorff Model),探討再不同濃度的Propofol灌注下對心臟收縮力及心率的直接作用。同時探討回復正常心率對心臟收縮力之影響。方法:第一階段(N=11)為利用兔子的離體心臟,藉由離體心臟冠狀動脈循環灌注不同濃度的Propofol(1, 5, 25, 50 mg/L)後,測量其左心室的壓力及收縮力(dp/dt單位時間內的壓力變化來表示)與心率。第二階段(N=7)除了給予不同濃度的Propofol灌注外,另外在完成不同濃度的Propofol灌注後,將兔子的心臟以心博控制器調整新率回基礎值,穩定後再紀錄左心室的壓力與收縮力,比較控制心率前後的差異。結果:左心室的壓力與收縮力與心率隨著給予Propofol的濃度增加而下降,尤其在給予高濃度(25和50 Mg/L)的情況下,達到顯著意義(P值小於0.05)。將兔子的心博速節律控制回基礎值後,發現左心室的壓力與收縮力並未跟著恢復。結論:Propofol隨著濃度的提高,心臟壓力及收縮力的抑制作用也會增強。另外,在給予Propofol高濃度下,也確實會降低心率。但,回復心率並無法回復心臟收縮力。
英文摘要
Background: The objective of the current study was to determine the direct effect of propofol on intact isolated rabbit heart using the modified Langendorff model. Methods: Eighteen rabbits were decerebrated under light ether anesthesia. Their hearts were then excised and prepared pursuant to the modified Langendorff model. Left ventricular pressure, left ventricular contractility (dp/ dt) and heart rate were recorded in the absence of propofol and in the presence of propofol of four different concentrations (1, 5, 25, 50 mg/L). In one group of hearts (N = 11) the heart rate was not paced. In another group of hearts (N = 7), the hearts were paced (during the control period and in propofol of each concentration) at a rate slightly higher than control rate and then allowed to revert to original state; pressure and contractility were measured and taken at both paced and unpaced rates. Results: In the unpaced group of hearts, a significant dose-dependent, negative effect on both left ventricular pressure and contractility was found at the two higher propofol concentrations (25 and 50 mg/L). A significant heart rate decrease was also revealed at these two concentrations. In the paced group, the left ventricular pressure and dp/dt also decreased significantly at higher propofol concentrations, and they did not return toward control values even though the heart was paced at the baseline unpaced rate. Conclusions: Propofol depressed left ventricular pressure and contractility and heart rate in a dose-dependent manner at higher concentrations. These negative cardiac effects were independent of changes in heart rate.
起訖頁 19-23
關鍵詞 心室壓力左心室功能心肌收縮心率PropofolVentricular pressureVentricular function, LeftMyocardial contractionHeart rate
刊名 麻醉學雜誌  
期數 200603 (44:1期)
出版單位 台灣麻醉醫學會
該期刊-上一篇 將杜卜勒組織超音波心圖影像的變異率應用在冠狀動脈繞道手術左心室功能變化的評估
該期刊-下一篇 閉鎖循環麻醉技術有利於麻醉病人在手術中維持良好的皮膚血流量
 

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