Steinhorn D M
Children's Hospital of Buffalo, State University of New York at Buffalo, New York 14222, USA.
J Crit Care. 1995 Jun;10(2):45-50. doi: 10.1016/0883-9441(95)90015-2.
To investigate the effect of pharmacological paralysis on systemic oxygen consumption to determine whether pharmacological paralysis offers a physiological benefit over adequate sedation in ventilated animals.
Nine dogs with normal pulmonary function were mechanically ventilated and sedated with alpha-chloralose while paralysis was induced with vecuronium. Oxygen consumption was determined via indirect calorimeter in each animal repeatedly in the presence or absence of paralysis with seven paired observations in each animal. Sixty-three pairs of data from nine animals were analyzed by analysis of variance with correction for multiple comparisons.
Oxygen consumption was 4.3% higher in the unblocked state compared with the blocked state (5.39 +/- 0.32 v 5.16 +/- 0.34 mL/kg-min, P < .001). Carbon dioxide production was 3.0% higher in the unblocked state compared with the blocked state (4.92 +/- 0.24 v 4.77 +/- 0.23 mL/kg-min, P < .01). No other physiological effects were noted.
Pharmacological paralysis of mechanically ventilated animals with normal pulmonary function that are sedated and resting comfortably produces a statistically significant reduction in oxygen consumption; however, the magnitude of this change is so small that little genuine clinical benefit would be anticipated.
研究药物性麻痹对全身氧耗的影响,以确定在机械通气动物中,药物性麻痹相较于充分镇静是否具有生理优势。
对9只肺功能正常的犬进行机械通气,并用α-氯醛糖进行镇静,同时用维库溴铵诱导麻痹。通过间接测热法在每只动物处于麻痹或非麻痹状态时反复测定氧耗,每只动物有7对配对观察值。对9只动物的63对数据进行方差分析并校正多重比较。
与麻痹状态相比,非阻断状态下的氧耗高4.3%(5.39±0.32对5.16±0.34毫升/千克·分钟,P<.001)。与阻断状态相比,非阻断状态下的二氧化碳产生量高3.0%(4.92±0.24对4.77±0.23毫升/千克·分钟,P<.01)。未观察到其他生理效应。
对肺功能正常、已镇静且舒适休息的机械通气动物进行药物性麻痹,可使氧耗在统计学上显著降低;然而,这种变化幅度很小,预计几乎没有真正的临床益处。