去甲肾上腺素对麻醉诱导性低血压的微血管和大循环影响：一项前瞻性初步研究。
Micro- and macrocirculatory effects of norepinephrine on anaesthesia-induced hypotension: a prospective preliminary study.
机构信息
Department of Anaesthesiology and Intensive Care, Lariboisière - Saint Louis Hospitals, 02 rue Ambroise Paré, 75010, Paris, France.
Inserm, UMRS-942, Paris Diderot University, 02, rue Ambroise Paré, 75010, Paris, France.
出版信息
BMC Anesthesiol. 2023 Nov 16;23(1):374. doi: 10.1186/s12871-023-02342-3.
BACKGROUND
Intraoperative arterial hypotension (IOH) leads to increased postoperative morbidity. Norepinephrine is often use to treat IOH. The question regarding the mode of administration in either a bolus or continuous infusion remains unanswered. The aim of the present study was to describe and compare the effects on macrocirculation and microcirculation of a bolus and a continuous infusion of norepinephrine to treat IOH.
METHODS
We conducted a prospective observational study with adult patients who underwent neurosurgery. Patients with invasive arterial blood pressure and cardiac output (CO) monitoring were screened for inclusion. All patients underwent microcirculation monitoring by video-capillaroscopy, laser doppler, near-infrared spectroscopy technology, and tissular CO. In case of IOH, the patient could receive either a bolus of 10 µg or a continuous infusion of 200 µg/h of norepinephrine. Time analysis for comparison between bolus and continuous infusion were at peak of MAP. The primary outcome was MFI by videocapillaroscopy.
RESULTS
Thirty-five patients were included, with 41 boluses and 33 continuous infusion. Bolus and continuous infusion induced an maximal increase in mean arterial pressure of +30[20-45] and +23[12-34] %, respectively (P=0,07). For macrocirculatory parameters, continuous infusion was associated with a smaller decrease in CO and stroke volume (p<0.05). For microcirculatory parameters, microvascular flow index (-0,1 vs. + 0,3, p=0,03), perfusion index (-12 vs. +12%, p=0,008), total vessel density (-0,2 vs. +2,3 mm2/mm2, p=0,002), showed significant opposite variations with bolus and continuous infusion, respectively.
CONCLUSIONS
These results on macro and microcirculation enlighten the potential benefits of a continuous infusion of norepinephrine rather than a bolus to treat anaesthesia-induced hypotension.
TRIAL REGISTRATION
(NOR-PHARM: 1-17-42 Clinical Trials: NCT03454204), 05/03/2018.
背景
术中低血压（IOH）会导致术后发病率增加。去甲肾上腺素常被用于治疗 IOH。但以推注还是连续输注的方式给药，目前仍没有定论。本研究旨在描述和比较推注和连续输注去甲肾上腺素治疗 IOH 对大循环和微循环的影响。
方法
我们进行了一项前瞻性观察性研究，纳入了接受神经外科手术的成年患者。筛选出接受有创动脉血压和心输出量（CO）监测的患者。所有患者均通过视频毛细血管镜、激光多普勒、近红外光谱技术和组织 CO 进行微循环监测。如果发生 IOH，患者可以接受 10μg 的推注或 200μg/h 的去甲肾上腺素连续输注。比较推注和连续输注的时间分析是在 MAP 峰值时进行的。主要结局是通过视频毛细血管镜测量的 MFI。
结果
共纳入 35 例患者，其中 41 例接受推注，33 例接受连续输注。推注和连续输注分别使平均动脉压最大升高+30[20-45]和+23[12-34]%（P=0.07）。对于大循环参数，连续输注与 CO 和每搏量的降低较小相关（p<0.05）。对于微循环参数，微血管血流指数（-0.1 对+0.3，p=0.03）、灌注指数（-12 对+12%，p=0.008）、总血管密度（-0.2 对+2.3mm2/mm2，p=0.002）分别与推注和连续输注呈显著相反的变化。
结论
这些关于大循环和微循环的结果提示，连续输注去甲肾上腺素治疗麻醉诱导性低血压可能比推注更有优势。
试验注册
（NOR-PHARM：1-17-42 临床试验：NCT03454204），2018 年 5 月 3 日。
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