Prengel A W, Lindner K H, Keller A, Lurie K G
Department of Anesthesiology and Critical Care Medicine, University of Ulm, Germany.
Crit Care Med. 1996 Dec;24(12):2014-9. doi: 10.1097/00003246-199612000-00014.
The administration of vasopressin during cardiopulmonary resuscitation (CPR) provides significantly more vital organ blood flow when compared with epinephrine during cardiac arrest in pigs. The effects of this potent vasoconstrictor on postresuscitation cardiovascular function remain unknown. The purpose of this study was to compare the effects of vasopressin and epinephrine on cardiovascular function in the postresuscitation phase after CPR.
Prospective, randomized, experimental study.
University research laboratory.
Domestic pigs, 12 to 14 wks of age.
Sixteen pigs were randomly allocated to receive either 0.045 mg/kg of epinephrine or 0.4 U/kg of vasopressin after 4 mins of cardiac arrest.
Hemodynamics, left ventricular contractility, and myocardial blood flow were measured for an interval of 240 mins after successful CPR. Differences between animals treated with epinephrine vs. vasopressin were most pronounced 15 mins after restoration of spontaneous circulation. At this time, mean aortic pressure was 64 +/- 6 (SEM) mm Hg in the epinephrine group and 84 +/- 6 mm Hg (p < .05) in the vasopressin group. Systemic vascular resistance was 1285 +/- 72 dyne.sec/cm5 in the epinephrine group and 2314 +/- 130 dyne.sec/cm5 (p < .001) in the vasopressin group. Cardiac index was 140 +/- 9 mL/min/kg in animals treated with epinephrine and 99 +/- 9 mL/min/kg (p < .01) in animals treated with vasopressin. Myocardial contractility (dp/ dtmax/P) was 52.8 +/- 3.4/sec with epinephrine as compared with 36.3 +/- 2.9 sec-1 (p < .01) with vasopressin. Left ventricular epicardial blood flow was 241 +/- 35 mL/min/100 g with epinephrine and 142 +/- 22 mL/min/100 g (p < .05) with vasopressin. Four hours after CPR, no significant differences were observed between groups.
In the early postresuscitation phase, vasopressin provided higher systemic blood pressures and there was a reversible depressant effect on myocardial function when compared with epinephrine. Overall cardiovascular function was not irreversibly or critically impaired after the administration of vasopressin in this pig model of cardiac arrest.
与肾上腺素相比，在猪心脏骤停期间进行心肺复苏（CPR）时给予血管加压素可显著增加重要器官的血流。这种强效血管收缩剂对复苏后心血管功能的影响尚不清楚。本研究的目的是比较血管加压素和肾上腺素对CPR后复苏期心血管功能的影响。
前瞻性、随机、实验性研究。
大学研究实验室。
12至14周龄的家猪。
16只猪在心脏骤停4分钟后随机分配接受0.045mg/kg肾上腺素或0.4U/kg血管加压素。
成功进行CPR后240分钟内测量血流动力学、左心室收缩力和心肌血流量。肾上腺素治疗组和血管加压素治疗组动物之间的差异在自主循环恢复后15分钟最为明显。此时，肾上腺素组的平均主动脉压为64±6（SEM）mmHg，血管加压素组为84±6mmHg（p<.05）。肾上腺素组的全身血管阻力为1285±72达因·秒/厘米⁵，血管加压素组为2314±130达因·秒/厘米⁵（p<.001）。肾上腺素治疗动物的心脏指数为140±9毫升/分钟/千克，血管加压素治疗动物的心脏指数为99±9毫升/分钟/千克（p<.01）。肾上腺素组的心肌收缩力（dp/dtmax/P）为52.8±3.4/秒，血管加压素组为36.3±2.9秒⁻¹（p<.01）。肾上腺素组左心室心外膜血流量为241±35毫升/分钟/100克，血管加压素组为142±22毫升/分钟/100克（p<.05）。CPR后4小时，两组之间未观察到显著差异。
在复苏后早期，与肾上腺素相比，血管加压素可提供更高的全身血压，且对心肌功能有可逆的抑制作用。在这个猪心脏骤停模型中，给予血管加压素后总体心血管功能并未受到不可逆转或严重的损害。
