Holzer Michael, Sterz Fritz, Behringer Wilhelm, Oschatz Elisabeth, Kofler Julia, Eisenburger Philip, Kittler Harald, Konschitzky Reinhard, Laggner Anton N
Department of Emergency Medicine, University of Vienna, Allgemeines Krankenhaus der Stadt Wien, Währinger Gürtel, 18-20 (6D), Austria.
Resuscitation. 2002 Dec;55(3):317-27. doi: 10.1016/s0300-9572(02)00211-3.
Since adrenaline (epinephrine) also has negative effects during and after cardiopulmonary resuscitation (CPR) a non-adrenergic vasoconstrictor like endothelin might be an alternative to increase vital organ blood flow. We studied the effect of different doses of endothelin-1 compared with adrenaline on the ability to resuscitate, cerebral and myocardial blood flow (MBF) in a closed chest cardiac arrest pig model. After 5 min of ventricular fibrillation, CPR with a ventilator and a mechanical compression device was started. At 10 min, 31 pigs were randomized to receive a single dose of endothelin-1 50, 100 or 200 microg or repeated doses of adrenaline 0.04 mg kg(-1) or saline every 3 min. After 25 min, the pigs were defibrillated to achieve restoration of spontaneous circulation. Blood flow was measured with the fluorescent microsphere method. In animals receiving endothelin-1 50, 100 and 200 microg the cerebral blood flow (CBF) increased from median 28 (25th; 75th quartile: 16; 40), 32 (15; 48) and 17 (4; 65) to 36 (31; 54), 47 (39; 57) and 63 (35; 83) ml min(-1) per 100 g, respectively, 6 min after drug administration (P<0.05 endothelin-1 50 microg vs. Control, P<0.01 endothelin-1 100 and 200 microg vs. Control). At the same time CBF decreased in the control and adrenaline group from 36 (21; 41) and 39 (15; 50) to 12 (2; 25) and 24 (15; 26) ml min(-1) per 100 g, respectively, (P<0.05 adrenaline vs. endothelin-1 200 microg). There was no difference in MBF between the treatment groups despite a higher coronary perfusion pressure (CoPP) in the endothelin-1 groups. Restoration of spontaneous circulation could be only achieved in the endothelin-1 50 microg (3 of 7; 43%) and 100 microg (5 of 7; 71%) group. This study suggests that endothelin-1 enhances CBF during CPR better than adrenaline and increases resuscitation success.
由于肾上腺素在心肺复苏（CPR）期间及之后也有负面影响，一种非肾上腺素能血管收缩剂如内皮素可能是增加重要器官血流的替代药物。我们在闭胸心脏骤停猪模型中研究了不同剂量的内皮素-1与肾上腺素相比对复苏能力、脑血流和心肌血流（MBF）的影响。在室颤5分钟后，开始使用呼吸机和机械按压装置进行CPR。10分钟时，31头猪被随机分为接受单剂量50、100或200微克内皮素-1，或每3分钟重复给予0.04毫克/千克肾上腺素或生理盐水。25分钟后，对猪进行除颤以恢复自主循环。采用荧光微球法测量血流。接受50、100和200微克内皮素-1的动物，给药6分钟后，脑血流（CBF）分别从中位数28（第25；75四分位数：16；40）、32（15；48）和17（4；65）增加到36（31；54）、47（39；57）和63（35；83）毫升/分钟/100克（内皮素-1 50微克组与对照组相比P<0.05，内皮素-1 100和200微克组与对照组相比P<0.01）。同时，对照组和肾上腺素组的CBF分别从36（21；41）和39（15；50）降至12（2；25）和24（15；26）毫升/分钟/100克（肾上腺素组与内皮素-1 200微克组相比P<l0.05）。尽管内皮素-1组的冠状动脉灌注压（CoPP）较高，但各治疗组之间的MBF没有差异。仅在内皮素-1 50微克组（7头中的3头；43%）和100微克组（7头中的5头；71%）实现了自主循环恢复。本研究表明，内皮素-1在CPR期间增强CBF的效果优于肾上腺素，并提高了复苏成功率。
