Department of Pediatrics, University of Alberta, Edmonton, AB, Canada.
Intensive Care Med. 2010 Jun;36(6):1058-66. doi: 10.1007/s00134-010-1820-x. Epub 2010 Mar 11.
After resuscitation, asphyxiated neonates often develop poor cardiac function with hypotension, pulmonary hypertension and multiorgan ischemia. In a swine model of neonatal hypoxia-reoxygenation, effects of epinephrine, dobutamine and milrinone on systemic, pulmonary and regional hemodynamics and oxygen transport were compared.
Controlled, block-randomized study.
University research laboratory.
Mixed breed piglets (1-3 days, 1.5-2.3 kg).
In acutely instrumented piglets, normocapnic alveolar hypoxia (10-15% oxygen) was induced for 2 h followed by reoxygenation with 100% oxygen (1 h) then 21% oxygen (3 h). At 2 h of reoxygenation, after volume loading (Ringer's lactate 10 ml/kg), either saline (placebo), epinephrine (0.5 microg/kg/min), dobutamine (20 microg/kg/min) or milrinone (0.75 microg/kg/min) were infused for 2 h in a blinded, block-randomized fashion (n = 6/group).
All medications similarly improved cardiac output, stroke volume and systemic oxygen delivery (vs. placebo-controls, p < 0.05). Epinephrine and dobutamine significantly increased, while milrinone maintained, mean arterial pressure over pretreatment values while placebo-treated piglets developed hypotension and shock. The mean arterial to pulmonary arterial pressures ratio was not different among groups. All medications significantly increased carotid and intestinal, but not renal, arterial blood flows and oxygen delivery, whereas milrinone caused lower renal vascular resistance than epinephrine and dobutamine-treated groups. Plasma troponin I, plasma and myocardial lactate levels, and histologic ischemic features were not different among groups.
In newborn piglets with hypoxia-reoxygenation, epinephrine, dobutamine and milrinone are effective inotropes to improve cardiac output, carotid and intestinal perfusion, without aggravating pulmonary hypertension. Milrinone may also improve renal perfusion.
在复苏后，窒息的新生儿常因低血压、肺动脉高压和多器官缺血而出现心功能不良。在新生猪缺氧-再氧合模型中，比较了肾上腺素、多巴酚丁胺和米力农对全身、肺和局部血流动力学及氧输送的影响。
对照、随机分组研究。
大学研究实验室。
混合品种小猪（1-3 天，1.5-2.3 公斤）。
在急性仪器化的小猪中，诱导正常碳酸血症性肺泡缺氧（10-15%氧气）2 小时，然后用 100%氧气（1 小时）和 21%氧气（3 小时）再氧合。在再氧合 2 小时后，在容量负荷（林格乳酸盐 10 ml/kg）后，用生理盐水（安慰剂）、肾上腺素（0.5μg/kg/min）、多巴酚丁胺（20μg/kg/min）或米力农（0.75μg/kg/min）以盲法、随机分组方式输注 2 小时（n = 6/组）。
所有药物均类似地改善了心输出量、每搏量和全身氧输送（与安慰剂对照组相比，p < 0.05）。肾上腺素和多巴酚丁胺显著增加，而米力农则维持了平均动脉压高于预处理值，而安慰剂治疗的小猪则出现低血压和休克。各组间平均动脉与肺动脉压力比无差异。所有药物均显著增加颈总动脉和肠动脉的血流和氧输送，但不增加肾动脉血流，而米力农引起的肾血管阻力低于肾上腺素和多巴酚丁胺治疗组。各组间血浆肌钙蛋白 I、血浆和心肌乳酸水平以及组织学缺血特征均无差异。
在新生猪缺氧-再氧合模型中，肾上腺素、多巴酚丁胺和米力农均为有效正性肌力药，可改善心输出量、颈动脉和肠灌注，而不加重肺动脉高压。米力农还可能改善肾功能灌注。
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