Cain S M, Curtis S E
Department of Physiology and Biophysics, University of Alabama, Birmingham 35294-0005.
Circ Shock. 1992 Nov;38(3):173-81.
We examined how volume resuscitation with and without dopexamine, a potent beta 2-adrenergic and dopaminergic agonist, would affect O2 uptake (VO2), O2 delivery (DO2), and lactate metabolism in whole body, skeletal muscle, and gut of 18 anesthetized dogs after they were infused for 1 hr with 2 mg/kg endotoxin. Six dogs were then infused with dextran for 2 hr at 0.5 ml/kg/min (DEX); another six were given the same volume with 12 micrograms/kg/min dopexamine (DPX); and a third group received no treatment (NT). After endotoxin, all animals were hypotensive; cardiac output decreased 30%; and DO2 to whole body, skeletal muscle, and gut were at or below critical for VO2. DO2 was raised above critical in whole body and gut of DEX and DPX but not in muscle of DPX, which produced lactate. Whole body DO2 approached preendotoxin level by 2 hr in DEX and DPX but stayed near critical in NT. At that time, gut VO2 was higher in DPX than in DEX or NT, and lactate efflux became less than in DEX. Vascular reactivity was present in the gut at the end of the experiment in six of six DPX studies, in four of six DEX studies, and in none of the NT studies. These results suggest that resuscitation with dopexamine + dextran after induction of endotoxic shock may be more beneficial than dextran alone, particularly for the gut mucosa.
我们研究了在18只麻醉犬静脉输注2mg/kg内毒素1小时后，使用或不使用多培沙明（一种强效的β2 - 肾上腺素能和多巴胺能激动剂）进行容量复苏，对全身、骨骼肌和肠道的氧摄取（VO2）、氧输送（DO2）以及乳酸代谢的影响。然后，将6只犬以0.5ml/kg/min的速度输注右旋糖酐2小时（DEX组）；另外6只犬以相同容量同时给予12μg/kg/min的多培沙明（DPX组）；第三组不进行治疗（NT组）。内毒素处理后，所有动物均出现低血压；心输出量下降30%；全身、骨骼肌和肠道的DO2降至VO2的临界值或更低。DEX组和DPX组的全身和肠道DO2升高至临界值以上，但DPX组的骨骼肌DO2未升高，且骨骼肌产生了乳酸。DEX组和DPX组在2小时时全身DO2接近内毒素处理前水平，但NT组仍接近临界值。此时，DPX组肠道的VO2高于DEX组或NT组，且乳酸流出量低于DEX组。实验结束时，DPX组6只犬中有6只、DEX组6只中有4只肠道存在血管反应性，而NT组均未出现。这些结果表明，在内毒素休克诱导后，使用多培沙明 + 右旋糖酐进行复苏可能比单独使用右旋糖酐更有益，特别是对肠道黏膜。
