Nozari A, Rubertsson S, Wiklund L
Department of Surgical Sciences/Anaesthesiology and Intensive Care, Uppsala University Hospital, SE-751 85 Uppsala, Sweden.
Resuscitation. 2001 Apr;49(1):59-72. doi: 10.1016/s0300-9572(00)00267-7.
Vasopressin has been investigated as a possible alternative to epinephrine during cardiopulmonary resuscitation (CPR). We tested the hypothesis that vasopressin, in comparison with epinephrine, would improve cerebral blood flow and metabolism during CPR as well as after restoration of spontaneous circulation (ROSC). A total of 22 anaesthetised piglets were subjected to 5 min of ventricular fibrillation followed by 8 min of closed-chest CPR. The piglets were randomly allocated to receive repeated boluses of either 45 microg/kg epinephrine or 0.4 U/kg vasopressin IV. Haemodynamic parameters, cerebral cortical blood flow and cerebral tissue pH and PCO(2) were continuously monitored during CPR and up to 4 h after ROSC. Cerebral oxygen extraction ratio was calculated. Cerebral cortical blood flow increased transiently after each bolus of epinephrine, while only the first bolus of vasopressin resulted in a sustained increase. The peak in cerebral cortical blood flow was reached approximately 30 s later with vasopressin. During the initial 5 min following ROSC, cerebral cortical blood flow was greater in the vasopressin group. In conclusion, there is a difference between epinephrine and vasopressin in the time from injection to maximal clinical response and the duration of their effect, but their overall effects on blood pressures and cerebral perfusion do not differ significantly during CPR. In contrast, vasopressin results in a greater cerebral cortical blood flow during a transient period after ROSC.
血管加压素已被作为心肺复苏（CPR）期间肾上腺素的一种可能替代物进行研究。我们检验了这样一个假设：与肾上腺素相比，血管加压素在心肺复苏期间以及自主循环恢复（ROSC）后能改善脑血流量和脑代谢。总共22只麻醉仔猪经历5分钟室颤，随后进行8分钟的闭胸心肺复苏。仔猪被随机分配接受静脉注射45微克/千克肾上腺素或0.4单位/千克血管加压素的重复推注。在心肺复苏期间以及自主循环恢复后长达4小时持续监测血流动力学参数、大脑皮质血流量、脑组织pH值和PCO₂。计算脑氧摄取率。每次推注肾上腺素后大脑皮质血流量短暂增加，而只有首次推注血管加压素导致持续增加。使用血管加压素时大脑皮质血流量峰值大约在30秒后达到。在自主循环恢复后的最初5分钟内，血管加压素组的大脑皮质血流量更高。总之，肾上腺素和血管加压素在从注射到最大临床反应的时间以及作用持续时间上存在差异，但在心肺复苏期间它们对血压和脑灌注的总体影响没有显著差异。相比之下，血管加压素在自主循环恢复后的一段短暂时间内会导致更高的大脑皮质血流量。
