咪达唑仑通过影响静脉血管张力增加兔内毒素休克期间的前负荷依赖性。

Midazolam increases preload dependency during endotoxic shock in rabbits by affecting venous vascular tone.

作者信息

Chen Jianxiao, Yu Tao, Longhini Federico, Zhang Xiwen, Liu Songqiao, Liu Ling, Yang Yi, Qiu Haibo

机构信息

Department of Critical Care Medicine, Zhongda Hospital, School of Medicine, Southeast University, 87 Dingjiaqiao Road, Nanjing, 210009, People's Republic of China.

Anesthesia and Intensive Care, Department of Translational Medicine, Eastern Piedmont University "A. Avogadro", Novara, Italy.

出版信息

Ann Intensive Care. 2018 May 2;8(1):59. doi: 10.1186/s13613-018-0403-9.

DOI:10.1186/s13613-018-0403-9

PMID:29721645

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC5931946/

Abstract

BACKGROUND

Septic patients often require sedation in intensive care unit, and midazolam is one of the most frequently used sedatives among them. But the interaction between midazolam and septic shock is not known. The aim of this study is to investigate the effects of midazolam on preload dependency in an endotoxic shock model by evaluating systemic vascular tone and cardiac function.

METHODS

Eighteen rabbits were randomly divided into three groups: Control group, MID1 group and MID2 group. Rabbits underwent ketamine anaesthesia and mechanical ventilation, and haemodynamic assessments were recorded in three groups (T0). Endotoxic shock was induced by lipopolysaccharide intravenously, and fluid resuscitation and norepinephrine were administered to obtain the baseline mean arterial pressure (MAP) (T1). Rabbits received equivalent normal saline (Control) and two consecutive dosages of midazolam: 0.3 mg kg h (MID1) and 3 mg kg h (MID2) (T2). Rabbits received another round of fluid challenge and norepinephrine infusion to return the MAP to normal (T3).

RESULTS

No significant differences in haemodynamic parameters were observed in three groups at T0, T1 or T3. Midazolam infusion significantly increased pulse pressure variation (PPV) and stroke volume variation (SVV) compared to the values in Control group, and MAP, central venous pressure (CVP), mean systemic filling pressure (Pmsf) and cardiac output (CO) decreased at T2. Same effects were observed with increasing doses of midazolam, and resistance for venous return (Rvr) decreased (MID1 vs. MID2) at T2. PPV and SVV increased significantly at T2 compared to the values at T1. MAP, CVP, Pmsf and CO decreased in MID1 and MID2 groups. Rvr also decreased in MID2 group (T2 vs. T1). Midazolam did not affect cardiac function index, systemic vascular resistance or artery resistance (T2 vs. T1).

CONCLUSIONS

Midazolam administration promoted preload dependency in septic shock models via decreased venous vascular tone without affecting cardiac function.

摘要

背景

脓毒症患者在重症监护病房常需镇静，咪达唑仑是其中最常用的镇静剂之一。但咪达唑仑与脓毒症休克之间的相互作用尚不清楚。本研究旨在通过评估全身血管张力和心功能，研究咪达唑仑对内毒素休克模型中前负荷依赖性的影响。

方法

18只兔子随机分为三组：对照组、MID1组和MID2组。兔子接受氯胺酮麻醉和机械通气，并记录三组的血流动力学评估值（T0）。通过静脉注射脂多糖诱导内毒素休克，并给予液体复苏和去甲肾上腺素以获得基线平均动脉压（MAP）（T1）。兔子接受等量生理盐水（对照组）和连续两剂咪达唑仑：0.3mg/kg·h（MID1）和3mg/kg·h（MID2）（T2）。兔子接受另一轮液体冲击和去甲肾上腺素输注以使MAP恢复正常（T3）。

结果

三组在T0、T1或T3时血流动力学参数无显著差异。与对照组相比，输注咪达唑仑显著增加脉压变异（PPV）和每搏量变异（SVV），且在T2时MAP、中心静脉压（CVP）、平均体循环充盈压（Pmsf）和心输出量（CO）降低。随着咪达唑仑剂量增加观察到相同效果，且在T2时静脉回流阻力（Rvr）降低（MID1组与MID2组）。与T1时相比，T2时PPV和SVV显著增加。MID1组和MID2组的MAP、CVP、Pmsf和CO降低。MID2组的Rvr也降低（T2与T1）。咪达唑仑不影响心功能指数、全身血管阻力或动脉阻力（T2与T1）。