Hoekstra J W, Van Ligten P, Neumar R, Werman H A, Anderson J, Brown C G
Division of Emergency Medicine, Ohio State University, Columbus 43210-1228.
Resuscitation. 1990 Jun;19(3):227-40. doi: 10.1016/0300-9572(90)90104-m.
Several animal studies have demonstrated an improvement in cerebral blood flow (CBF) and myocardial blood flow (MBF) after the administration of epinephrine (E) 0.20 mg/kg during closed chest CPR. The administration of norepinephrine (NE) in doses of 0.12 and 0.16 mg/kg demonstrated a trend toward improved CBF and MBF during CPR over that seen with E 0.20 mg/kg in the same animal model. The purpose of this study was to compare the effects of a higher dose of NE 0.20 mg/kg to E 0.20 mg/kg to determine if increasing doses of NE would demonstrate further improvement in CBF and MBF during CPR. Fourteen immature swine were anesthetized and instrumented for regional blood flow and hemodynamic measurements. After 10 min of ventricular fibrillation (VF), CPR was begun using a mechanical thumper. After 3 min of CPR, the animals received either E 0.20 mg/kg (n = 7) or NE 0.20 mg/kg (n = 7) through a right atrial catheter. CPR was continued for an additional 3.5 min and defibrillation was then attempted. CBF (ml/min/100 g), MBF (ml/min/100 g), myocardial oxygen delivery (MDo2; ml O2/min/100 g), myocardial oxygen consumption (MVo2; ml O2/min/100 g), and myocardial oxygen extraction ratios (ER, MVo2/MDo2) were measured during normal sinus rhythm (NSR), during CPR, and during CPR following drug administration. Following drug administration, CBF, MBF, MDo2 and MVo2 rose while ER fell in both E and NE groups. There were no significant differences between groups in CBF, ER, or intravascular pressures following drug administration (P greater than or equal to 0.07). The NE group demonstrated significantly higher MBF (118.9 +/- 73.1 vs. 62.2 +/- 45.3, P = 0.04), MVo2 (14.2 +/- 7.7 vs. 7.0 +/- 3.8, P = 0.05), and MDo2 (19.9 +/- 13.4 versus 9.4 +/- 6.3, P = 0.05) compared to the E group following drug administration While NE improved MBF and MDo2 over E during CPR, there was a trend toward lower resuscitation rates with NE (57.1% vs. 85.7% P = 0.56). Any benefit of higher MBF and MDo2 with NE 0.20 mg/kg appears to be offset by proportionately high MVo2 and a trend toward lower resuscitation rates in the NE 0.20 mg/kg animals.
多项动物研究表明，在闭胸心肺复苏期间给予0.20mg/kg肾上腺素（E）后，脑血流量（CBF）和心肌血流量（MBF）有所改善。在同一动物模型中，给予剂量为0.12mg/kg和0.16mg/kg的去甲肾上腺素（NE）显示，与给予0.20mg/kg E相比，心肺复苏期间CBF和MBF有改善趋势。本研究的目的是比较更高剂量的0.20mg/kg NE与0.20mg/kg E的效果，以确定增加NE剂量是否会在心肺复苏期间使CBF和MBF进一步改善。14只未成熟猪麻醉后进行区域血流和血流动力学测量。心室颤动（VF）10分钟后，使用机械按压装置开始心肺复苏。心肺复苏3分钟后，通过右心房导管给动物注射0.20mg/kg E（n = 7）或0.20mg/kg NE（n = 7）。继续心肺复苏3.5分钟，然后尝试除颤。在正常窦性心律（NSR）、心肺复苏期间以及给药后心肺复苏期间测量CBF（ml/min/100g）、MBF（ml/min/100g）、心肌氧输送（MDo2；ml O2/min/100g）、心肌氧消耗（MVo2；ml O2/min/100g）和心肌氧摄取率（ER，MVo2/MDo2）。给药后，E组和NE组的CBF、MBF、MDo2和MVo2均升高，而ER降低。给药后两组间CBF、ER或血管内压力无显著差异（P≥0.07）。与给药后的E组相比，NE组的MBF（118.9±73.1对62.2±45.3，P = 0.04）、MVo2（14.2±7.7对7.0±3.8，P = 0.05）和MDo2（19.9±13.4对9.4±6.3，P = 0.05）显著更高。虽然在心肺复苏期间NE比E能改善MBF和MDo2，但NE组的复苏率有降低趋势（57.1%对85.7%，P = 0.56）。0.20mg/kg NE使MBF和MDo2升高带来的任何益处似乎被0.20mg/kg NE组中过高的MVo2和复苏率降低趋势所抵消。
