Hämodynamische Effekte unter intravenöser Infusion von Nifedipin (Adalat®) bei kardiochirurgischen Patienten

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Abstract
Bei 64 Patienten eines koronarchirurgischen Krankenguts wurden die hämodynamischen Veränderungen unter Infusion von 0,35 μg/kg KG/min und 0,70 μg/kg KG/min Nifedipin (Adalat®) untersucht: Zusammenfassend führte die Gabe von Nifedipin zu einer Senkung der Nachlast ohne Minderung der Kontraktilität, was als ökonomisierender Effekt auf die Herzarbeit angesehen werden kann. The haemodynamic effects of 0.35 μg/kg bw/min and 0.70 μg/kg bw/min nifedipine (Adalat®) as an infusion have been studied in 64 patients undergoing aortocoronary bypass surgery. The measurements were performed at four different times: 1. before induction of anaesthesia, 2. after induction of anaesthesia, 3. before cannulation of the aorta, 4. during extracorporeal circulation (ECC). In a follow-up study haemodynamics were controlled in detail after weaning from ECC. Each group was compared to a control group having received 0.9 % NaCl as placebo. Preoperative as well as intraoperative application of nifedipine led to a decrease in arterial pressure and total systemic resistance, whereas cardiac index showed an increase. Heart rate, central venous pressure, pulmonary artery and pulmonary capillary wedge pressure remained almost unchanged. No relevant effect on contractility could be seen. During ECC nifedipine led to a decrease in arterial perfusion pressure and oxygenator-volume, thus indicating arterial vasodilatation and venous pooling. The investigations after ECC demonstrated stabilisation in cardiac rhythm and myocardial function. In conclusion, dose-depent haemodynamic changes after intravenous application of nifedipine indicate a reduction in myocardial oxygen demand without detrimental effects on myocardial performance.

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