Tu Zi-zhi, Dimopoulos George, Sun Qing-hua, Lobo Suzana M, De Backer Daniel, Xiao Xian-zhong, Vincent Jean-Louis
Department of Pathophysiology, Xiangya Medical Colloge, Central South University, Changsha 410078, Hunan, China.
Zhongguo Wei Zhong Bing Ji Jiu Yi Xue. 2005 Feb;17(2):71-5.
To compare the effects of dobutamine under different fluids resuscitation for shock induced by intestinal ischemia/reperfusion (I/R) injury in rabbits.
Thirty-two anesthetized rabbits were randomized into four groups of eight animals each. The groups were followed as: (1) lactated Ringer's solution (LRS) resuscitation; (2) LRS+hydroxyethyl starch solution (HES) resuscitation; (3) LRS resuscitation+dobutamine treatment; (4) LRS+HES resuscitation+dobutamine treatment. All these rabbits underwent the intestinal I/R injury developed by occluding superior mesenteric artery (SMA) with a non-crushing vascular clamp for 60 minutes and then loosing the clamp for 300 minutes. The fluid resuscitation and drug treatment began at the same time of reperfusion. Hemodynamic parameters including mean artery pressure (MAP), heart rate (HR), aortic velocity (AoV, as cardiac output) and SMA blood flow (Qsma) were measured. Tissue oxygenation was assessed indirectly by measuring the tonometric parameters of the gut, including difference between partial pressure of carbon dioxide in intestinal intramucosal and partial pressure of carbon dioxide in arterial blood (Pt-a CO2 gap), intestinal intramucosal pH (pHi), arterial blood lactate acid concentration and oxygen delivery (DO2).
HR, AoV and Qsma as measured in two dobutamine groups were significantly higher in values than LRS and LRS+HES groups (all P<0.05). But MAP as measured in two dobutamine groups were significantly higher in values than only LRS (P<0.05), and in LRS+HES resuscitation+dobutamine treatment group was also significantly higher in values than LRS resuscitation+dobutamine treatment group (P<0.05). Dobutamine in LRS resuscitation+dobutamine treatment and LRS+HES resuscitation+dobutamine treatment group could greatly decrease lactate and Pt-aCO2 gap, significantly improve pHi and DO2 compared with other two resuscitation groups (all P<0.05). Dobutamine in LRS+HES resuscitation+dobutamine treatment group could also greatly decrease lactate and Pt-aCO2 gap, significantly improve pHi compared with LRS resuscitation+dobutamine treatment group (all P<0.05).
Dobutamine could improve hemodynamic parameters and tissue oxygenation in shock induced by intestinal I/R injury in rabbits, being better used under the LRS+HES resuscitation.
比较不同液体复苏情况下多巴酚丁胺对兔肠缺血/再灌注（I/R）损伤所致休克的影响。
将32只麻醉兔随机分为4组，每组8只。分组如下：（1）乳酸林格氏液（LRS）复苏组；（2）LRS+羟乙基淀粉溶液（HES）复苏组；（3）LRS复苏+多巴酚丁胺治疗组；（4）LRS+HES复苏+多巴酚丁胺治疗组。所有兔均通过用无损伤血管夹夹闭肠系膜上动脉（SMA）60分钟，然后松开血管夹300分钟来造成肠I/R损伤。液体复苏和药物治疗在再灌注同时开始。测量血流动力学参数，包括平均动脉压（MAP）、心率（HR）、主动脉流速（AoV，作为心输出量）和SMA血流量（Qsma）。通过测量肠道张力测定参数间接评估组织氧合，包括肠黏膜内二氧化碳分压与动脉血二氧化碳分压之差（Pt-a CO2差值）、肠黏膜内pH（pHi）、动脉血乳酸浓度和氧输送（DO2）。
两个多巴酚丁胺组测量的HR、AoV和Qsma值显著高于LRS组和LRS+HES组（均P<0.05）。但两个多巴酚丁胺组测量的MAP值显著高于仅LRS组（P<0.05），且LRS+HES复苏+多巴酚丁胺治疗组的MAP值也显著高于LRS复苏+多巴酚丁胺治疗组（P<0.05）。与其他两个复苏组相比，LRS复苏+多巴酚丁胺治疗组和LRS+HES复苏+多巴酚丁胺治疗组中的多巴酚丁胺可大幅降低乳酸和Pt-aCO2差值，显著改善pHi和DO2（均P<0.05）。与LRS复苏+多巴酚丁胺治疗组相比，LRS+HES复苏+多巴酚丁胺治疗组中的多巴酚丁胺也可大幅降低乳酸和Pt-aCO2差值，显著改善pHi（均P<0.05）。
多巴酚丁胺可改善兔肠I/R损伤所致休克的血流动力学参数和组织氧合，在LRS+HES复苏情况下使用效果更佳。
