Karzai W, Reilly J M, Hoffman W D, Cunnion R E, Danner R L, Banks S M, Parrillo J E, Natanson C
Critical Care Medicine Department, Warren Grant Magnuson Clinical Center, National Institutes of Health, Bethesda 20892.
Am J Physiol. 1995 Feb;268(2 Pt 2):H692-702. doi: 10.1152/ajpheart.1995.268.2.H692.
To study how sepsis affects hemodynamic responses to catecholamines and fluids, either Escherichia coli-infected (septic, n = 8) or sterile (controls, n = 6) fibrin clots were implanted intraperitoneally into 2-yr-old beagles. Hemodynamics were measured at each of four doses of dopamine (0, 5, 10, and 20 micrograms.kg-1.min-1) and norepinephrine (0, 10, 20, and 40 micrograms.min-1), before and after infusion of fluid (Ringer 40 ml.kg-1). Septic animals had lower mean arterial pressure (MAP, P = 0.04), stroke volume index (SVI, P = 0.0001), and left ventricular (LV) ejection fraction (LVEF) (P = 0.0001) than controls. During this time, increasing doses of dopamine and norepinephrine produced corresponding increases (P < 0.001) in LVEF, SVI, and MAP. However, during sepsis, the ability of dopamine to increase MAP diminished, while its ability to increase LVEF and SVI was maintained. Conversely, the ability of norepinephrine to increase LVEF and SVI diminished, but its ability to increase MAP was maintained. During sepsis, fluids alone increased (P < 0.05) MAP, LVEF, SVI, and cardiac index (CI). Fluids with catecholamines also significantly increased (P < 0.05) MAP with only minimal increases in LVEF, SVI, and CI. These data demonstrate that during sepsis without catecholamines, fluids improve cardiac performance and systemic pressures, but with catecholamines, fluids have minimal effects on cardiac performance and augment MAP. Furthermore, during sepsis dopamine is more effective than norepinephrine in increasing LV performance, but norepinephrine is more effective than dopamine in increasing systemic pressures.
为研究脓毒症如何影响对儿茶酚胺和液体的血流动力学反应，将大肠杆菌感染的（脓毒症组，n = 8）或无菌的（对照组，n = 6）纤维蛋白凝块腹腔内植入2岁的比格犬体内。在输注液体（林格氏液40 ml.kg-1）前后，分别测量四种剂量多巴胺（0、5、10和20微克.kg-1.min-1）和去甲肾上腺素（0、10、20和40微克.min-1）时的血流动力学。脓毒症动物的平均动脉压（MAP，P = 0.04）、每搏量指数（SVI，P = 0.0001）和左心室（LV）射血分数（LVEF）（P = 0.0001）均低于对照组。在此期间，多巴胺和去甲肾上腺素剂量增加时，LVEF、SVI和MAP相应增加（P < 0.001）。然而，在脓毒症期间，多巴胺升高MAP的能力减弱，而其升高LVEF和SVI的能力得以维持。相反，去甲肾上腺素升高LVEF和SVI的能力减弱，但其升高MAP的能力得以维持。在脓毒症期间，单纯液体输注可使MAP、LVEF、SVI和心脏指数（CI）升高（P < 0.05）。液体与儿茶酚胺联合应用时也可使MAP显著升高（P < 0.05），而LVEF、SVI和CI仅轻度升高。这些数据表明，在无儿茶酚胺的脓毒症期间，液体可改善心脏功能和全身压力，但与儿茶酚胺联合应用时，液体对心脏功能影响极小而增强MAP。此外在脓毒症期间多巴胺在增加左心室功能方面比去甲肾上腺素更有效，但去甲肾上腺素在升高全身压力方面比多巴胺更有效。
