Inotropes in Cardiac Surgery - Mike Poullis - Consultant 正性肌力药物在心脏外科手术-麦克poullis咨询.pptVIP

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2018-06-06 发布于浙江
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Inotropes in Cardiac Surgery - Mike Poullis - Consultant 正性肌力药物在心脏外科手术-麦克poullis咨询.ppt

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Inotropes in Cardiac Surgery - Mike Poullis - Consultant 正性肌力药物在心脏外科手术-麦克poullis咨询

Inotropes in Cardiac Surgery Basics Cardiac Cycle Phase 1 - Atrial Contraction Phase 2 - Isovolumetric Contraction Phase 3 - Rapid Ejection Phase 4 - Reduced Ejection Phase 5 - Isovolumetric Relaxation Phase 6 - Rapid Filling Phase 7 - Reduced Filling Sympathetic / Parasympathetic Starlings Law BEFORE INOTROPES Fluid Bolus Legs up Rhythm ECG, SR, slow, fast, paced on ventricle, ST’s, ectopics Tamponade CVP, BE, UO, temp, CXR, echo Bleeding Drains, CXR, Hb Pneumothorax CXR, examine, vent alarms Fight Ventilator Paralyse, sedate or extubate Which Inotrope Ohms Law V=I x R BP=CO x SVR Simple terms Low or high cardiac output, what is the PA pressure Inotropes Atropine Ca2+ Dopamine Dopexamine Dobutamine Adrenaline Noradrenaline Isoprenaline Enoximone Aminophylline Vasopressin Methylene blue NO Receptors Atropine Antimuscurinic ie causes tachycardia Some pateints have muscurinic receptors on ventricle as well ie inotropic Increases HR CO=SV x HR Ca2+ Inotrope and vasoconstrictor Short acting Beware radial artery patients Warn patient if awake Dopamine Acts on dopamine receptors on heart and kidney Causes a tachycardia (CO=SV x HR) Increases urine output in some patients Less metabolic side effects compared with adrenaline Beware patients with tachycardia (give k+, Mg2+) Dopexamine Tachycardia Increase splanchnic and renal blood flow VASODILATOR Beware Vasodilated patients Dobutamine Like dopamine Has less effect on pulmonary artery pressure good for mitral valve patients Adrenaline Excellent inotrope but dirty Increased heart rate and inotropy (?1-adrenoceptor mediated) Vasoconstriction in most systemic arteries and veins (postjunctional a 1 and a 2 adrenoceptors) Vasodilation in muscle and liver vasculatures at low concentrations (b2-adrenoceptor); vasoconstriction at high concentrations (a1-adrenoceptor mediated) Adrenaline Noradrenaline Vasoconstrictor Increased heart rate and increased inotropy (?1-adrenoceptor mediated) Vasoconstriction