Biomedical Engineering, Faculty of Engineering, University of Manitoba, Winnipeg, Canada.
Section of Neurosurgery, Department of Surgery, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada.
Pharmacol Res Perspect. 2020 Oct;8(5):e00655. doi: 10.1002/prp2.655.
Intravenous norepinephrine (NE) is utilized commonly in critical care for cardiovascular support. NE's impact on cerebrovasculature is unclear and may carry important implications during states of critical neurological illness. The aim of the study was to perform a scoping review of the literature on the cerebrovascular/cerebral blood flow (CBF) effects of NE. A search of MEDLINE, BIOSIS, EMBASE, Global Health, SCOPUS, and Cochrane Library from inception to December 2019 was performed. All manuscripts pertaining to the administration of NE, in which the impact on CBF/cerebral vasculature was recorded, were included. We identified 62 animal studies and 26 human studies. Overall, there was a trend to a direct vasoconstriction effect of NE on the cerebral vasculature, with conflicting studies having demonstrated both increases and decreases in regional CBF (rCBF) or global CBF. Healthy animals and those undergoing cardiopulmonary resuscitation demonstrated a dose-dependent increase in CBF with NE administration. However, animal models and human patients with acquired brain injury had varied responses in CBF to NE administration. The animal models indicate an increase in cerebral vasoconstriction with NE administration through the alpha receptors in vessels. Global and rCBF during the injection of NE displays a wide variation depending on treatment and model/patient.
静脉内去甲肾上腺素（NE）在重症监护中常用于心血管支持。NE 对脑血管的影响尚不清楚，在严重神经疾病状态下可能具有重要意义。本研究的目的是对有关 NE 对脑血管/脑血流（CBF）影响的文献进行范围综述。从 MEDLINE、BIOSIS、EMBASE、全球健康、SCOPUS 和 Cochrane Library 从建立到 2019 年 12 月进行了检索。所有涉及 NE 给药的文献，记录了对 CBF/脑血管的影响，均被纳入。我们确定了 62 项动物研究和 26 项人体研究。总体而言，NE 对脑血管有直接的血管收缩作用，一些研究表明区域性 CBF（rCBF）或全脑 CBF 增加和减少。健康动物和接受心肺复苏的动物，随着 NE 给药剂量的增加，CBF 呈剂量依赖性增加。然而，获得性脑损伤的动物模型和人类患者对 NE 给药的 CBF 反应不同。动物模型表明，NE 通过血管中的 alpha 受体增加脑血管收缩。根据治疗和模型/患者的不同，NE 注射期间的全脑和 rCBF 显示出很大的差异。
