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Inhalatives und intravenöses Prostazyklin während der Ein-Lungen-Ventilation

Hämodynamische und pulmonale Effekte

Aerosolized and intravenous prostacyclin during one-lung ventilation

Hemodynamic and pulmonary effects

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Zusammenfassung

Fragestellung.

Bei zahlreichen intrathorakalen Eingriffen erleichtert die Ein-Lungen-Ventilation (ELV) das chirurgische Vorgehen. Bedingt durch die hypoxische pulmonale Vasokonstriktion (HPV) als Folge der Atelektase einer Lunge resultiert jedoch ein Anstieg des pulmonalarteriellen Druckes. Untersucht wurde der Einfluss von inhalativem im Vergleich zu intravenösem Prostaglandin I2 (Prostazyklin, PGI2) hinsichtlich einer selektiven Senkung des pulmonalen Hypertonus (PHT).

Methodik.

Bei 11 narkotisierten, einseitig ventilierten Schweinen wurde PGI2 als Infusion (5–20 ng/kg KG/min) und Aerosol (4–16 ng/kg KG/min) verabreicht. Als Kontrolle dienten die gleichen Tiere vor und nach der PGI2-Applikation.

Ergebnisse.

Intravenöses PGI2 führte zu einer signifikanten Abnahme von pulmonalem (PVR) und systemischem Gefäßwiderstand (SVR). Bei gleichzeitigem Anstieg des „cardiac index“ (CI) änderten sich arterieller (MAP) und pulmonalarterieller Mitteldruck (MPAP) nur gering. Während der Inhalation von PGI2 war dagegen eine signifikante Abnahme des PVR (−21,4 bis −32,8%) und MPAP (−12,0 bis −17,8%) ohne Beeinflussung von SVR, MAP und CI zu beobachten. Der arterielle Sauerstoffpartialdruck (paO2) änderte sich nicht signifikant.

Schlussfolgerung.

Nur inhalatives PGI2 bewirkte während der ELV eine selektive pulmonale Vasodilatation.

Abstract

Background.

One-lung ventilation is frequently used in thoracic surgery. However, hypoxic pulmonary vasoconstriction of the atelectatic lung may produce pulmonary hypertension. The objective of the present study was to compare the acute effects of intravenous versus aerosolized prostacyclin (PGI2) on pulmonary and systemic circulation.

Methods.

PGI2 was administered in 11 anesthetized and unilaterally ventilated pigs by infusion (5, 10, and 20 ng/kg body weight/min) and by inhalation (4, 8, and 16 ng/kg body weight/min) in a cross-over design.

Results.

Infusion of PGI2 reduced both pulmonary (PVR) and systemic vascular resistance (SVR). Due to a concomitant increase in cardiac index (CI) mean arterial (MAP) and pulmonary artery pressures (MPAP) did not change significantly. In contrast, aerosolized PGI2 produced a significant decrease in PVR (−21.4 to −32.8%) and MPAP (−12.0 to −17.8%) without affecting SVR, MAP, and CI. Arterial oxygenation tension (paO2) was not affected.

Conclusion.

During one-lung ventilation only aerosolized prostacyclin produced a selective pulmonary vasodilation.

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Danksagung

Wir danken der Else Kröner-Fresenius-Stiftung, Bad Homburg v.d.H., für die finanzielle Förderung der vorliegenden Arbeit im Rahmen des Projektes „Pulmonale Hypertonie und Hypoxie unter Ein-Lungen-Ventilation“.

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Der korrespondierende Autor versichert, dass keine Verbindungen mit einer Firma, deren Produkt in dem Artikel genannt ist, oder einer Firma, die ein Konkurrenzprodukt vertreibt, bestehen.

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Authors and Affiliations

  1. Klinik für Anästhesiologie, Albert-Schweitzer-Krankenhaus, Northeim

    M. Bund

  2. Klinik für Anästhesiologie, Universitätsklinikum, Aachen

    D. Henzler, R. Rossaint & R. Kuhlen

  3. Klinik für Innere Medizin, Florence-Nightingale-Krankenhaus, Düsseldorf

    R. Walz

  4. Zentrum Anästhesiologie, Medizinische Hochschule, Hannover

    S. Piepenbrock

  5. Klinik für Anästhesiologie, operative Intensivmedizin und Schmerztherapie, Albert-Schweitzer-Krankenhaus, Sturmbäume 8–10, 37154, Northeim

    M. Bund

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Correspondence to M. Bund.

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Bund, M., Henzler, D., Walz, R. et al. Inhalatives und intravenöses Prostazyklin während der Ein-Lungen-Ventilation. Anaesthesist 53, 612–620 (2004). https://doi.org/10.1007/s00101-004-0683-3

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