左西孟旦可增加心肺复苏后脑组织氧水平,与心功能和脑灌注无关。
Levosimendan increases brain tissue oxygen levels after cardiopulmonary resuscitation independent of cardiac function and cerebral perfusion.
机构信息
Department of Anesthesiology, Medical Center, Johannes Gutenberg-University, Langenbeckstraße 1, 55131, Mainz, Germany.
Max Planck Institute for Polymer Research, Ackermannweg 10, 55128, Mainz, Germany.
出版信息
Sci Rep. 2021 Jul 9;11(1):14220. doi: 10.1038/s41598-021-93621-x.
Prompt reperfusion is important to rescue ischemic tissue; however, the process itself presents a key pathomechanism that contributes to a poor outcome following cardiac arrest. Experimental data have suggested the use of levosimendan to limit ischemia-reperfusion injury by improving cerebral microcirculation. However, recent studies have questioned this effect. The present study aimed to investigate the influence on hemodynamic parameters, cerebral perfusion and oxygenation following cardiac arrest by ventricular fibrillation in juvenile male pigs. Following the return of spontaneous circulation (ROSC), animals were randomly assigned to levosimendan (12 µg/kg, followed by 0.3 µg/kg/min) or vehicle treatment for 6 h. Levosimendan-treated animals showed significantly higher brain PbtO levels. This effect was not accompanied by changes in cardiac output, preload and afterload, arterial blood pressure, or cerebral microcirculation indicating a local effect. Cerebral oxygenation is key to minimizing damage, and thus, current concepts are aimed at improving impaired cardiac output or cerebral perfusion. In the present study, we showed that NIRS does not reliably detect low PbtO levels and that levosimendan increases brain oxygen content. Thus, levosimendan may present a promising therapeutic approach to rescue brain tissue at risk following cardiac arrest or ischemic events such as stroke or traumatic brain injury.
再灌注对于拯救缺血组织很重要;然而,这个过程本身存在一个关键的病理机制,会导致心脏骤停后的不良后果。实验数据表明,左西孟旦可通过改善脑微循环来限制缺血再灌注损伤。然而,最近的研究对此效应提出了质疑。本研究旨在探讨在室颤导致的幼年雄性猪心脏骤停后,左西孟旦对血流动力学参数、脑灌注和氧合的影响。自主循环恢复(ROSC)后,动物随机分为左西孟旦(12μg/kg,随后以 0.3μg/kg/min 的速度输注)或载体治疗 6 小时。左西孟旦治疗的动物显示出明显更高的脑 PbtO 水平。这种作用并没有伴随心输出量、前负荷和后负荷、动脉血压或脑微循环的变化,提示这是一种局部作用。脑氧合是最小化损伤的关键,因此,目前的概念旨在改善受损的心输出量或脑灌注。在本研究中,我们表明 NIRS 不能可靠地检测到低 PbtO 水平,并且左西孟旦增加了脑氧含量。因此,左西孟旦可能为心脏骤停或缺血事件(如中风或创伤性脑损伤)后有风险的脑组织提供一种有前途的治疗方法。
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