去甲肾上腺素能有效挽救因激光诱导的冲击波所致肺爆震伤的小鼠。

Noradrenalin effectively rescues mice from blast lung injury caused by laser-induced shock waves.

作者信息

Miyawaki Hiroki, Saitoh Daizoh, Hagisawa Kohsuke, Noguchi Midori, Sato Shunichi, Kinoshita Manabu, Miyazaki Hiromi, Satoh Yasushi, Harada Nahoko, Sakamoto Toshihisa

机构信息

Department of Traumatology and Critical Care Medicine, National Defense Medical College Hospital, 3-2 Namiki, Tokorozawa, 359-8513, Japan.

Division of Traumatology, Research Institute, National Defense Medical College, 3-2 Namiki, Tokorozawa, 359-8513, Japan.

出版信息

Intensive Care Med Exp. 2015 Dec;3(1):32. doi: 10.1186/s40635-015-0069-7. Epub 2015 Dec 10.

DOI:10.1186/s40635-015-0069-7

PMID:26662813

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC4675774/

Abstract

BACKGROUND

Blast lung injuries (BLI) caused by blast waves are extremely critical in the prehospital setting, and hypotension is thought to be the main cause of death in such cases. The present study aimed to elucidate the pathophysiology of severe BLI using laser-induced shock wave (LISW) and identify the initial treatment.

METHODS

The current investigation comprised two parts. For the validation study, mice were randomly allocated to groups that received a single shot of 1.2, 1.3, or 1.4 J/cm(2) LISW to both lungs. The survival rates, systolic blood pressure (sBP), heart rate (HR), peripheral oxyhemoglobin saturation (SpO2), and shock index were monitored for 60 min, and lung tissues were analyzed histopathologically. The study evaluated the effects of catecholamines as follows. Randomly assigned mice received 1.4 J/cm(2) LISW followed by the immediate intraperitoneal administration of dobutamine, noradrenalin, or normal saline. The primary outcome was the survival rate. Additionally, sBP, HR, SpO2, and the shock index were measured before and 5 and 10 min after LISW, and the cardiac output, left ventricular ejection fraction, and systemic vascular resistance (SVR) were determined before and 1 min after LISW.

RESULTS

The triad of BLI (hypotension, bradycardia, and hypoxemia) was evident immediately after LISW. The survival rates worsened with increasing doses of LISW (100 % in 1.2 J/cm(2) vs. 60 % in 1.3 J/cm(2), 10 % in 1.4 J/cm(2)). The histopathological findings were compatible with those of human BLI. The survival rate in LISW high group (1.4 J/cm(2)) was highest in the group that received noradrenalin (100 %), with significantly elevated SVR values (from 565 to 1451 dyn s/min(5)). In contrast, the survival rates in the dobutamine and normal saline groups were 40 and 10 %, respectively, and the SVR values did not change significantly after LISW in either group.

CONCLUSIONS

The main cause of death during the initial phase of severe BLI is hypotension due to the absence of peripheral vasoconstriction. Therefore, the immediate administration of noradrenalin may be an effective treatment during the initial phase of severe BLI.

摘要

背景

爆炸波引起的爆震性肺损伤（BLI）在院前环境中极其危急，低血压被认为是此类病例的主要死因。本研究旨在利用激光诱导冲击波（LISW）阐明重度BLI的病理生理学，并确定初始治疗方法。

方法

本研究包括两个部分。在验证研究中，将小鼠随机分为三组，分别接受单次1.2、1.3或1.4 J/cm²的LISW冲击双侧肺部。监测60分钟内的生存率、收缩压（sBP）、心率（HR）、外周血氧饱和度（SpO2）和休克指数，并对肺组织进行组织病理学分析。本研究如下评估了儿茶酚胺的作用。随机分配的小鼠接受1.4 J/cm²的LISW，随后立即腹腔注射多巴酚丁胺、去甲肾上腺素或生理盐水。主要结局为生存率。此外，在LISW前以及LISW后5分钟和10分钟测量sBP、HR、SpO2和休克指数，并在LISW前和LISW后1分钟测定心输出量、左心室射血分数和全身血管阻力（SVR）。

结果

LISW后立即出现BLI三联征（低血压、心动过缓和低氧血症）。随着LISW剂量增加，生存率恶化（1.2 J/cm²组为100%，1.3 J/cm²组为60%，1.4 J/cm²组为10%）。组织病理学结果与人类BLI相符。LISW高剂量组（1.4 J/cm²）中接受去甲肾上腺素组的生存率最高（100%），SVR值显著升高（从565增至1451 dyn s/min⁵）。相比之下，多巴酚丁胺组和生理盐水组的生存率分别为40%和10%，两组LISW后SVR值均未显著变化。