Li Hongliang, Zhu Xi, Yao Gaiqi, Wang Zongyu
Department of Intensive Care, Peking University Third Hospital, Beijing, China.
Department of Intensive Care, Peking University Third Hospital, Beijing, China.
J Surg Res. 2015 May 1;195(1):271-6. doi: 10.1016/j.jss.2015.01.016. Epub 2015 Jan 13.
In recent years, microcirculatory blood flow alterations have been recognized to be stronger predictors of septic shock treatment outcomes than global hemodynamic variables.
In our self-controlled, interventional pilot clinical trial study, we investigated the effects of a single papaverine injection on the microcirculation in sepsis patients undergoing fluid resuscitation combined with vasopressor treatments. Fourteen septic shock patients admitted to the Peking University Third Hospital were included in the study, and each patient received 30 mg papaverine, which is the approximate dosage used to treat a conventional arterial spasm. Papaverine was administered as an intravenous bolus injection after systemic hemodynamic stabilization had been achieved by means of fluid resuscitation combined with dopamine and/or norepinephrine vasopressor medication. Baseline characteristics, as well as global hemodynamic and blood gas parameters, before and 60 min after papaverine injection were recorded and sublingual microcirculatory data at baseline and 15, 30, and 60 min after papaverine administration obtained using sidestream dark-field video microscopy.
The perfused vessel density of small vessels was significantly increased 30 and 60 min after papaverine administration (P < 0.01), and the proportion of perfused small vessels (PPV), as well as the microvascular flow index, was significantly increased 30 min after papaverine (P < 0.05). There were no visible systemic effects, arrhythmia, or hypotension during the observation period in each patient.
In our pilot study, papaverine transiently improved sublingual microcirculatory blood flow without influencing systemic hemodynamics in patients with septic shock, who required vasoconstrictors to maintain blood pressure during fluid resuscitation.
近年来，微循环血流改变已被认为是脓毒性休克治疗结果比整体血流动力学变量更强的预测指标。
在我们的自身对照、干预性先导临床试验研究中，我们调查了单次注射罂粟碱对接受液体复苏联合血管升压药治疗的脓毒症患者微循环的影响。北京大学第三医院收治的14例脓毒性休克患者纳入研究，每位患者接受30mg罂粟碱，这是用于治疗传统动脉痉挛的大致剂量。在通过液体复苏联合多巴胺和/或去甲肾上腺素血管升压药实现全身血流动力学稳定后，将罂粟碱作为静脉推注给药。记录罂粟碱注射前和注射后60分钟的基线特征以及整体血流动力学和血气参数，并使用侧流暗视野视频显微镜获得罂粟碱给药前、给药后15、30和60分钟的舌下微循环数据。
罂粟碱给药后30和60分钟，小血管的灌注血管密度显著增加（P<0.01），罂粟碱给药后30分钟，灌注小血管比例（PPV）以及微血管血流指数显著增加（P<0.05）。在观察期间，每位患者均未出现明显的全身效应、心律失常或低血压。
在我们的先导研究中，罂粟碱可短暂改善脓毒性休克患者的舌下微循环血流，而不影响全身血流动力学，这些患者在液体复苏期间需要血管收缩剂来维持血压。
