Endoh H, Honda T, Ohashi S, Shimoji K
Department of Emergency & Critical Care Medicine, Niigata University School of Medicine, Niigata, Japan.
Crit Care Med. 2001 Mar;29(3):623-7. doi: 10.1097/00003246-200103000-00027.
To investigate the effects of naloxone and morphine during acute hypoxia.
Prospective, randomized animal study.
University laboratory.
Twenty-eight adult male Sprague Dawley rats, weighing 300-350 g.
The rats were implanted with a femoral catheter and subcutaneous electrodes for electrocardiogram recording and were randomly assigned to receive morphine (5 mg/kg), naloxone (5 mg and 10 mg/kg), or normal saline (control) (n = 7 in each). Fifteen minutes after intraperitoneal injection of the drug, each rat was exposed to hypoxic gas (5% oxygen, 95% N2) for 70 mins. Hypoxic survival time was measured. Mean arterial pressure (MAP), arterial pH, Paco2, Pao2, and base excess were measured before injection (baseline), 14 mins after injection (H0), and 6 mins (H1), 33 mins (H2), and 48 mins (H3) after exposure to hypoxia.
Hypoxic survival was similar between the naloxone 5 mg/kg and control groups (p = .183), significantly lower in the naloxone 10 mg/kg group (p < .01), and significantly higher in the morphine 5 mg/kg group (p < .05) compared with controls. MAP significantly decreased in all groups. However, at H2-H3, MAP was better preserved in both naloxone groups and was lower in the morphine group compared with controls. Paco2 was maintained higher at H0-H3 in the morphine group and lower at H2-H3 in both naloxone groups compared with controls.
During acute hypoxia, naloxone preserves arterial blood pressure and attenuates hypoxic ventilatory depression by antagonizing endogenous opiates, but it does not improve hypoxic survival. In contrast, morphine, which enhances the action of endogenous opiates, does improve hypoxic survival. The acute hypoxic tolerance of morphine may be partly attributable to a depression of oxygen consumption, increased cerebral blood flow secondary to high Paco2, and protective actions mediated by delta-opioid receptors.
研究纳洛酮和吗啡在急性缺氧期间的作用。
前瞻性随机动物研究。
大学实验室。
28只成年雄性Sprague Dawley大鼠,体重300 - 350克。
大鼠植入股动脉导管和皮下电极用于记录心电图,并随机分为接受吗啡(5毫克/千克)、纳洛酮(5毫克和10毫克/千克)或生理盐水(对照组)(每组n = 7)。腹腔注射药物15分钟后,每只大鼠暴露于低氧气体(5%氧气,95%氮气)中70分钟。测量低氧存活时间。在注射前(基线)、注射后14分钟(H0)以及暴露于低氧后6分钟(H1)、33分钟(H2)和48分钟(H3)测量平均动脉压(MAP)、动脉pH值、动脉血二氧化碳分压(Paco2)、动脉血氧分压(Pao2)和碱剩余。
纳洛酮5毫克/千克组与对照组的低氧存活情况相似(p = 0.183),纳洛酮10毫克/千克组显著降低(p < 0.01),吗啡5毫克/千克组与对照组相比显著升高(p < 0.05)。所有组的MAP均显著下降。然而,在H2 - H3时,与对照组相比,两个纳洛酮组的MAP保持得更好,而吗啡组的MAP更低。与对照组相比,吗啡组在H0 - H3时Paco2维持在较高水平,两个纳洛酮组在H2 - H3时Paco2较低。
在急性缺氧期间,纳洛酮通过拮抗内源性阿片类物质来维持动脉血压并减轻低氧性通气抑制,但不能改善低氧存活情况。相比之下,增强内源性阿片类物质作用的吗啡确实能改善低氧存活情况。吗啡的急性低氧耐受性可能部分归因于氧消耗的降低、高Paco2继发的脑血流量增加以及由δ-阿片受体介导的保护作用。