Berg R A, Otto C W, Kern K B, Sanders A B, Hilwig R W, Hansen K K, Ewy G A
Department of Pediatrics, University of Arizona College of Medicine, Tucson.
Crit Care Med. 1994 Feb;22(2):282-90. doi: 10.1097/00003246-199402000-00020.
To determine whether high-dose epinephrine (0.2 mg/kg) during cardiopulmonary resuscitation (CPR) results in improved outcome, compared with standard-dose epinephrine (0.02 mg/kg).
A prospective, randomized, blinded study.
Research laboratory of a university medical center.
Thirty domestic swine were randomized to receive standard- or high-dose epinephrine during CPR after 15 mins of fibrillatory cardiac arrest. Three minutes of CPR were provided, followed by advanced cardiac life support per American Heart Association guidelines. Animals that were successfully resuscitated were supported for 2 hrs in an intensive care unit (ICU) setting, and then observed for 24 hrs.
Electrocardiogram, aortic blood pressure, right atrial blood pressure, and end-tidal CO2 were monitored continuously until the intensive care period ended. Survival and neurologic outcome were determined. Return of spontaneous circulation was attained in 14 of 15 animals in each group. Four of 14 high-dose epinephrine pigs died during the ICU period after return of spontaneous circulation vs. zero of the 14 standard-dose pigs (p < .05). Six standard-dose pigs survived 24 hrs vs. four high-dose pigs. Twenty-four-hour survival rate and neurologic outcome were not significantly different. Within 10 mins of defibrillation, severe hypertension (diastolic pressure > 120 mmHg) occurred in 12 of 14 high-dose pigs vs. two of 14 standard-dose pigs (p < .01). Severe tachycardia (heart rate > 250 beats/min) occurred in seven of 14 high-dose pigs vs. zero of 14 standard-dose pigs (p < .01). All four high-dose epinephrine pigs that died during the ICU period experienced both severe hypertension and tachycardia immediately postresuscitation.
High-dose epinephrine did not improve 24-hr survival rate or neurologic outcome. Immediately after return of spontaneous circulation, most animals in the high-dose epinephrine group exhibited a hyperadrenergic state that included severe hypertension and tachycardia. High-dose epinephrine resulted in a greater early mortality rate.
与标准剂量肾上腺素（0.02mg/kg）相比，确定心肺复苏（CPR）期间大剂量肾上腺素（0.2mg/kg）是否能改善预后。
一项前瞻性、随机、盲法研究。
一所大学医学中心的研究实验室。
30头家猪在发生心室颤动性心脏骤停15分钟后，随机分为在CPR期间接受标准剂量或大剂量肾上腺素治疗组。进行3分钟的CPR，然后按照美国心脏协会指南进行高级心脏生命支持。成功复苏的动物在重症监护病房（ICU）环境中维持2小时，然后观察24小时。
持续监测心电图、主动脉血压、右心房血压和呼气末二氧化碳，直至重症监护期结束。确定生存率和神经功能预后。每组15只动物中有14只实现了自主循环恢复。14只接受大剂量肾上腺素治疗的猪中有4只在自主循环恢复后的ICU期间死亡，而14只接受标准剂量治疗的猪无一死亡（p<0.05）。14只接受标准剂量治疗的猪中有6只存活24小时，而接受大剂量治疗的猪有4只存活。24小时生存率和神经功能预后无显著差异。在除颤后10分钟内，14只接受大剂量肾上腺素治疗的猪中有12只出现严重高血压（舒张压>120mmHg），而14只接受标准剂量治疗的猪中有2只出现（p<0.01）。14只接受大剂量肾上腺素治疗的猪中有7只出现严重心动过速（心率>250次/分钟），而14只接受标准剂量治疗的猪无一出现（p<0.01）。在ICU期间死亡的4只接受大剂量肾上腺素治疗的猪在复苏后立即出现严重高血压和心动过速。
大剂量肾上腺素并未提高24小时生存率或改善神经功能预后。自主循环恢复后，大剂量肾上腺素组的大多数动物立即出现高肾上腺素能状态，包括严重高血压和心动过速。大剂量肾上腺素导致更高的早期死亡率。
