阿拉明和去甲肾上腺素对感染性休克猪血流动力学和氧代谢的影响

    The Impact of Aramine and Norepinephrine on Hemodynamics and Oxygen Metabolism in Septic Shock Pigs

    • 摘要: 目的 探讨阿拉明和去甲肾上腺素对感染性休克猪血流动力学和氧代谢的影响。 方法 成年小型猪10只,静脉泵入大肠埃希氏菌脂多糖建立感染性休克模型,随机分为阿拉明组及去甲肾上腺素组。模型制备稳定1 h后按感染性休克集束化治疗,阿拉明组在基础治疗上使用阿拉明提升血压,去甲肾上腺素组采用去甲肾上腺素提升血压。在治疗前(T0)及治疗1/2 h(T1/2)、1 h (T1)、2 h(T2)、3 h(T3)使用脉搏指示连续心排出量监测仪观察并记录心率、平均动脉压、心指数、系统血管阻力指数;血气分析检测血氧饱和度、混合静脉血氧饱和度及乳酸水平并计算氧输送指数、氧耗指数、氧摄取率以及乳酸清除率。 结果 大肠埃希氏菌脂多糖持续静脉泵入成功制备感染性休克模型猪,血管活性药物处理后两组模型的血流动力学指标均得到显著改善(P=0.000),与阿拉明组相比,在T2、T3时去甲肾上腺素组心率(t=2.317、t=2.474)、平均动脉压(t=2.284、t=2.313)明显较高(P值均<0.05),去甲肾上腺素组在T2时系统血管阻力指数显著大于阿拉明组(t=2.884,P<0.05),在T1、T2、T3时去甲肾上腺素组的心指数均明显大于阿拉明组(t=3.360、t=3.058、t=2.559,P值均<0.05);两组模型的组织氧代谢指标均得到显著改善(P<0.05),血清乳酸水平显著下降(P=0.000),与阿拉明组相比,去甲肾上腺素组在T2、T3时氧输送指数(t=2.832、t=2.680)、氧耗指数(t=2.519、t=2.713)以及血氧饱和度(t=2.167、t=2.560)均明显大于阿拉明组(P值均<0.05);去甲肾上腺素组的乳酸水平在T1、T2、T3显著低于阿拉明组(t=2.807、t=3.285、t=2.938,P值均<0.05),去甲肾上腺素组乳酸清除率明显高于阿拉明组(t=4.939,P=0.000)。 结论 阿拉明和去甲肾上腺素均能有效的改善感染性休克模型猪的血流动力学状态和组织氧代谢,去甲肾上腺素较阿拉明起效快,更有效。

       

      Abstract: Objective To investigate the impact of Aramine and Norepinephrine on hemodynamics and oxygen metabolism in septic shock pigs. Methods Ten adult miniature pigs, septic shock models established by intravenous pumping of Escherichia coli lipopolysaccharides, were randomized to the group of Aramine or the group of Norepinephrine. Septic shock pigs were treated according to sepsis shock bundle strategy 1 hour after stable model establishment. Aramine was added to the basic treatment to increase blood pressure in the group of Aramine and, similarly, Norepinephrine was added to increase blood pressure in the group of Norepinephrine. The pulse-indicated continuous cardiac output (PiCCO) monitor was used to record heart rate (HR), mean arterial pressure (MAP), cardiac index (CI), systemic vascular resistance index (SVRI) and arterial blood gas analysis was used to test oxygen saturation (SaO2), oxygen saturation of mixed venous blood (SvO2) and lactate levels as well as calculating oxygen delivery index (DO2I), oxygen consumption index (VO2I), oxygen extraction rate (O2ext) and the lactate clearance rate before treatment (T0) and 1/2 hour, 1 hour, 2 hours and 3 hours after treatment (T1/2, T1, T2 and T3). Results Septic shock pig models were successfully established by continuously intravenous pumping of Escherichia coli lipopolysaccharides and the hemodynamic parameters were significantly improved in both groups after using vasoactive agents (P=0.000). The HR(t=2.317, t=2.474) and MAP(t=2.284,t=2.313) in T2 and T3 in the group of Norepinephrine were significantly higher than that in the group of Aramine (P<0.05). The SVRI in T2 in the group of Norepinephrine was significantly higher than that in the group of Aramine (t=2.884,P<0.05). The CI in T1, T2 and T3 in the group of Norepinephrine was significantly higher than that in the group of Aramine (t=3.360, t=3.058,t=2.559, P<0.05). The tissue oxygen metabolism parameters of DO2I, VO2I, O2ext and SvO2 were significantly improved (P<0.05) and serum lactate levels were significantly declined (P=0.000) in two groups. The DO2I(t=2.832, t=2.680), VO2I (t=2.519, t=2.713)and SvO2t=2.167, t=2.560) in T2 and T3 in the group of Norepinephrine was significantly higher than that in the group of Aramine (P<0.05). The serum lactate levels in T1, T2 and T3 in the group of Norepinephrine were significantly lower (t=2.807, t=3.285, t=2.938, P<0.05) and the lactate clearance rate was significantly higher than that in the group of Aramine (t=4.939,P=0.000). Conclusions Both Aramine and Norepinephrine can effectively improve hemodynamics and oxygen metabolism in septic shock pigs and Norepinephrine takes effect more quickly and effectively than Aramine.

       

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