Αιμοδυναμικές και αναπνευστικές επιδράσεις της θειϊκής πρωταμίνης σε σχέση με την οδό και τον ρυθμό χορήγησης: Πειραματική μελέτη

The present study was undertaken in order to observe the haemodynamic and respiratory changes after administration of Protamine Sulfate (PS), in relation to the site and rate of injection. Thirty-six mongrel dogs were divided into six equal groups: I, II, III, IV, V and VI. They were all anesthetized and mechanically ventilated with a Servo 900 C ventilator. Left femoral artery was cannulated for arterial pressure monitoring and blood sampling. A thermodilution pulmonary artery catheter was inserted through the left femoral vein for calculation of cardiac output, measurement of pulmonary vascular pressures and sampling of mixed venous blood. Through the ventilatory circuit, end-tidal CO₂ and compliance were continuously monitored with Analyzer CO₂ 930-Siemens and Lung mechanics calculator 940-Siemens. ECG monitoring, all pressures measurements and recordings and cardiac output determination were made with a KONE-565A monitor with a six-channel recorder and a CANON-PJ 1080 A printer. All animals were given heparine 5 mg/Kg and after 10 min. an 1:1 solution of PS at a dose of 10 mg/Kg was infused as follows: Group I: slow infusion via a peripheral vein (left radial), Group II: rapid infusion via the same vein, Group III: slow infusion into the right atrium, Group IV: rapid infusion into the right atrium, Groups V and VI: slow and rapid infusion into anscending aorta respectively. During and at the end of infusion, as well as 15, 30 and 45 min after it all measured parameters were recorded and arterial and mixed venous blood was sampled. Parameters observed included: Mean Arterial Pressure (MAP), Heart Rate (HR), Cardiac Index (CI), Mean Pulmonary Artery Pressure (MPAP), Pulmonary Capillary Wedge Pressure (PCWP), Systemic Vascular Resistance (SVR), Pulmonary Vascular Resistance (PVR), Left Ventricular Stroke Work Index (LVSWI), Right Ventricular Stroke Work Index (RVSWI, Arteriovenous admixture (Qs/Qt), PaO₂, PvO₂, End-tidal CO₂ (ETCO₂) and Compliance. Statistical analysis was performed using Kruskal-Wallis and Wilcoxon tests. In all groups there was a transient but statistically significant decrease in MAP, CI and LVSWI with an increase in HR, PCWP, MPAP and PVR, while SVR and RVSWI remained unchanged. We also observed a significant decrease in PaO₂, PvO₂, ETCO₂ and compliance, with no significant changes of Qs/Qt. A negative inotropic effect is obvious, although we did not use load independent methods for the evaluation of contractility. There are strong indications that more than one mechanisms are responsible for the cardiovascular and respiratory response to PS. Rapid administration of PS via a peripheral vein was associated with the most severe haemodynamic and respiratory changes. Cardiovascular, effects were surprisingly minimal during rapid central venous infusion, while intraaortic infusions proved the most «benign» regarding hypoxaemia and pulmonary mechanics alterations. In view of these findings, it is clear that no particular site or rate of injection could be recommended as absolutely safe. Adequate dilution and slow administration via a peripheral vein seems to be quite reasonable for at least early recognition and treatment of any undesirable reaction to PS.

Grantor dc:publisher

Aristotle University Of Thessaloniki (AUTH)

Year dc:date

1990

Author dc:creator

• Τσιώρα, Βασιλική

• Ιατρική και Επιστήμες Υγείας
• Βασική Ιατρική
• Κλινική Ιατρική
• Medical and Health Sciences
• Basic Medicine
• Clinical Medicine

Language dc:language

gre

Identifier

10.12681/eadd/1470

OAI identifier oai:identifier

oai:10442/1470