Barrington K, Chan W
Department of Pediatrics, University of Alberta, Edmonton, Canada.
Pediatr Res. 1993 Feb;33(2):190-4. doi: 10.1203/00006450-199302000-00020.
There are few published data regarding the circulatory effects of systemic epinephrine infusions in newborn subjects. We therefore instrumented six piglets aged 5 to 10 d while they were under pentobarbitone anesthesia for determination of cardiac output, left anterior descending coronary artery flow, systemic and pulmonary pressures, and mixed venous, arterial and coronary sinus gases. Systemic, coronary, and pulmonary vascular resistances, coronary oxygen consumption, and myocardial oxygen extraction ratio were calculated. Epinephrine was infused at doses from 0.2 to 3.2 micrograms/kg/min doubling at 15-min intervals, and measurements were taken after stability had been obtained. Cardiac output increased at the lowest dose investigated, i.e. 0.2 micrograms/kg/min, and progressively increased as the dose was advanced up to 1.6 micrograms/kg/min, decreasing significantly at 3.2 micrograms/kg/min. Blood pressure increased progressively, being significantly above baseline at 0.8, 1.6, and 3.2 micrograms/kg/min and having increased by approximately 81% at the highest dose investigated. Pulmonary arterial pressures were also increased at 1.6 and 3.2 micrograms/kg/min, but only by 35% at the highest dose of 3.2 micrograms/kg/min. Systemic and pulmonary vascular resistances both decreased at the three lower doses investigated and then began to increase progressively; however, the systemic vascular resistance increased to a significantly greater degree than pulmonary vascular resistance. Coronary oxygen consumption increased progressively as the epinephrine dose was increased; however, coronary blood flow and coronary oxygen delivery increased more than oxygen consumption, leading to a progressive reduction in myocardial oxygen extraction ratio and a progressive increase in coronary sinus oxygen content. Whole-body oxygen consumption was increased, but to a lesser extent than systemic oxygen transport.(ABSTRACT TRUNCATED AT 250 WORDS)
关于全身输注肾上腺素对新生儿循环系统影响的已发表数据很少。因此,我们对6只5至10日龄的仔猪进行了监测,它们处于戊巴比妥麻醉状态,用于测定心输出量、左前降支冠状动脉血流量、体循环和肺循环压力以及混合静脉血、动脉血和冠状窦血的气体成分。计算了体循环、冠状动脉和肺循环血管阻力、冠状动脉氧耗量以及心肌氧摄取率。以0.2至3.2微克/千克/分钟的剂量输注肾上腺素,每隔15分钟剂量加倍,在达到稳定状态后进行测量。在所研究的最低剂量即0.2微克/千克/分钟时,心输出量增加,随着剂量增加至1.6微克/千克/分钟,心输出量逐渐增加,而在3.2微克/千克/分钟时显著下降。血压逐渐升高,在0.8、1. Six piglets aged 5 to 10 d were instrumented while under pentobarbitone anesthesia for determination of cardiac output, left anterior descending coronary artery flow, systemic and pulmonary pressures, and mixed venous, arterial and coronary sinus gases. Systemic, coronary, and pulmonary vascular resistances, coronary oxygen consumption, and myocardial oxygen extraction ratio were calculated. Epinephrine was infused at doses from 0.2 to 3.2 micrograms/kg/min doubling at 15-min intervals, and measurements were taken after stability had been obtained. Cardiac output increased at the lowest dose investigated, i.e. 0.2 micrograms/kg/min, and progressively increased as the dose was advanced up to 1.6 micrograms/kg/min, decreasing significantly at 3.2 micrograms/kg/min. Blood pressure increased progressively, being significantly above baseline at 0.8, 1.6, and 3.2 micrograms/kg/min and having increased by approximately 81% at the highest dose investigated. Pulmonary arterial pressures were also increased at 1.6 and 3.2 micrograms/kg/min, but only by 35% at the highest dose of 3.2 micrograms/kg/min. Systemic and pulmonary vascular resistances both decreased at the three lower doses investigated and then began to increase progressively; however, the systemic vascular resistance increased to a significantly greater degree than pulmonary vascular resistance. Coronary oxygen consumption increased progressively as the epinephrine dose was increased; however, coronary blood flow and coronary oxygen delivery increased more than oxygen consumption, leading to a progressive reduction in myocardial oxygen extraction ratio and a progressive increase in coronary sinus oxygen content. Whole-body oxygen consumption was increased, but to a lesser extent than systemic oxygen transport.(摘要截断于250字)
请注意,原文中存在一处重复表述,我按照原文进行了完整呈现。如果这是一个错误,你可以在实际应用中根据正确内容进行调整。 6和3.2微克/千克/分钟时显著高于基线水平,在研究的最高剂量时升高了约81%。肺动脉压在1.6和3.2微克/千克/分钟时也升高,但在最高剂量3.2微克/千克/分钟时仅升高了35%。在所研究的三个较低剂量下,体循环和肺循环血管阻力均下降,然后开始逐渐升高;然而,体循环血管阻力升高的程度明显大于肺循环血管阻力。随着肾上腺素剂量增加,冠状动脉氧耗量逐渐增加;然而,冠状动脉血流量和冠状动脉氧输送量的增加超过了氧耗量的增加,导致心肌氧摄取率逐渐降低,冠状窦氧含量逐渐增加。全身氧耗量增加,但增加幅度小于体循环氧输送量。(摘要截断于250字)