在动物插管模型中，病理学影响迷走神经刺激后的血压变化。

Pathology influences blood pressure change following vagal stimulation in an animal intubation model.

机构信息

Critical Care Group - Portex Unit, Institute of Child Health, University College London, United Kingdom ; Assistance Publique-Hôpitaux de Paris, Réanimation Pédiatrique, Hôpital Robert Debré, Paris, France.

出版信息

PLoS One. 2013 Aug 21;8(8):e69957. doi: 10.1371/journal.pone.0069957. eCollection 2013.

DOI:10.1371/journal.pone.0069957

PMID:23990892

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC3749158/

Abstract

PURPOSE

The haemodynamic response to critical care intubation is influenced by the use of sedation and relaxant drugs and the activation of the vagal reflex. It has been hypothesized that different disease states may have a contrasting effect on the cardiovascular response to vagal stimulation. Our objective was to determine whether the blood pressure response to vagal stimulation was modified by endotoxaemia or hypovolaemia.

METHODS

New Zealand White rabbits were anaesthetised with urethane before tracheotomy. The exposed left Vagus nerve of randomised groups of control (n = 11), endotoxin (n = 11, 1 mg/kg), hypovolaemia 40% (n = 8) and hypovolaemia 20% (n = 8) rabbits were subjected to 10 Hz pulsed electrical stimulations of 25 s duration every 15 min. Haemodynamic parameters were recorded from a catheter in the right carotid artery connected to an iWorx monitor. Serum catecholamines were measured every 30 min using reverse-phase ion-pairing liquid chromatography. The change in blood pressure after vagal stimulation was compared to controls for one hour after the first death in the experimental groups.

RESULTS

29% of the rabbits died in the hypovolaemia 40% group and 27% in the endotoxin group. One rabbit died in the hypovolaemia 40% group before vagal stimulation and was excluded. Following electrical stimulation of the Vagus nerve there was a fall in blood pressure in control rabbits. Blood pressure was conserved in the hypovolaemic rabbits compared to controls (p<0.01). For the endotoxaemic rabbits, there was a non-significant trend for the mean blood pressure to decrease more than the controls. Serum catecholamines were significantly raised in both the hypovolaemic and endotoxaemic rabbits.

CONCLUSIONS

Pathology may contribute to modifications in blood pressure when vagal activation occurs. Patients who are either already vasoconstricted, or not vasoplegic, may be less at risk from intubation-related vagally mediated reductions in blood pressure than those with vasodilatory pathologies.

摘要

目的

在重症监护插管时，血流动力学反应受到镇静和松弛药物的使用以及迷走反射的激活的影响。有人假设，不同的疾病状态可能对迷走刺激引起的心血管反应产生相反的影响。我们的目的是确定内毒素血症或低血容量是否会改变迷走刺激引起的血压反应。

方法

新西兰白兔用尿烷麻醉后进行气管切开术。随机分为对照组（n=11）、内毒素组（n=11，1mg/kg）、低血容量 40%组（n=8）和低血容量 20%组（n=8）的暴露的左侧迷走神经每隔 15 分钟接受 25 秒的 10Hz 脉冲电刺激。通过连接到 iWorx 监视器的右颈动脉中的导管记录血流动力学参数。使用反相离子对液相色谱法每 30 分钟测量一次血清儿茶酚胺。在实验组的第一例死亡后，将迷走刺激后的血压变化与对照组进行比较，持续一个小时。

结果

40%低血容量组有 29%的兔子死亡，内毒素组有 27%的兔子死亡。在进行迷走神经电刺激之前，40%低血容量组有一只兔子死亡并被排除。在对迷走神经进行电刺激后，对照组兔子的血压下降。与对照组相比，低血容量兔子的血压得到了维持（p<0.01）。对于内毒素血症兔子，平均血压下降的趋势比对照组更为显著。低血容量和内毒素血症兔子的血清儿茶酚胺明显升高。