Shatney C H, Dietzman R H, Lillehei R C
Adv Shock Res. 1980;3:123-32.
This study was undertaken to determine if a portion of intravenously administered methylprednisolone sodium succinate (MPSS) might be metabolized by the lung during cardiogenic shock. With plastic microsphere coronary artery embolization, myocardial infarction and shock were produced in mongrel dogs. Animals were assigned to control, intra-arterial MPSS, and intravenous MPSS groups, with the treated dogs receiving 30 mg/kg of MPSS 15 minutes after infarction. Compared to control animals, the group receiving intra-arterial MPSS had significantly higher mean blood pressure, cardiac index, and blood glucose levels and a lower peripheral resistance during shock. Compared with the intravenous MPSS group, dogs treated with intra-arterial MPSS had significantly lower peripheral resistance and a nearly significantly higher cardiac index. Permanent survival rates were 26% in the control group, 60% in the intravenous MPSS group, and 50% in the intra-arterial MPSS group. Although treatment with intra-arterial MPSS was associated with a better hemodynamic profile than that following intravenous MPSS (suggesting the possibility of corticosteroid metabolism by the lung), survival was not enhanced. It was concluded that functionally insignificant amounts of corticosteroids given intravenously might be inactivated by the lung. Hence, intravenous MPSS injection is a practical and adequate means of administering this valuable agent in cardiogenic shock.
本研究旨在确定在心源性休克期间，静脉注射的琥珀酸钠甲泼尼龙（MPSS）的一部分是否可能被肺代谢。通过塑料微球冠状动脉栓塞，在杂种犬中诱发心肌梗死和休克。将动物分为对照组、动脉内注射MPSS组和静脉注射MPSS组，治疗组的犬在梗死后15分钟接受30mg/kg的MPSS。与对照动物相比，接受动脉内注射MPSS的组在休克期间平均血压、心脏指数和血糖水平显著更高，外周阻力更低。与静脉注射MPSS组相比，接受动脉内注射MPSS治疗的犬外周阻力显著更低，心脏指数几乎显著更高。对照组的永久存活率为26%，静脉注射MPSS组为60%，动脉内注射MPSS组为50%。尽管动脉内注射MPSS治疗与比静脉注射MPSS更好的血流动力学特征相关（提示肺可能对皮质类固醇进行代谢），但存活率并未提高。得出的结论是，静脉给予的功能上无显著意义的皮质类固醇量可能被肺灭活。因此，静脉注射MPSS是在心源性休克中给予这种有价值药物的一种实用且充分的方法。
