Nordin A, Mäkisalo H, Mildh L, Höckerstedt K
Fourth Department of Surgery, Helsinki University Hospital, Finland.
Crit Care Med. 1997 Apr;25(4):663-8. doi: 10.1097/00003246-199704000-00018.
To evaluate the effects of dopexamine administration on hemodynamic variables and tissue oxygen tensions during crystalloid resuscitation from hemorrhagic shock.
Randomized, control trial.
An animal laboratory at a university center.
Twelve piglets, mean weight 22 kg.
The animals were anesthetized and bled to a state of hemorrhagic shock and resuscitated, using a crystalloid solution infused at a rate of approximately 2.6 mL/min/kg (total amount 208 mL/kg). Cardiac output and mean arterial pressure (MAP were measured as indicators of volume filling during the 20- to 30-min resuscitation period and during the follow-up period until 80 mins from the start of resuscitation. Dopexamine was administered by infusion at 6 micrograms/kg-min from the start of volume replacement (dopexamine group, n = 6). The rest of the animals (control group, n = 6) were given volume replacement only.
Systemic oxygen transport variables were calculated. Tissue oxygen tensions were continuously recorded from the liver, conjunctival layer, and via subcutaneous and transcutaneous electrodes in the abdominal region. MAP decreased from 119 +/- 2 (SEM) to 44 +/- 2 mm Hg and cardiac output decreased by 77% during the shock period. During resuscitation, cardiac output was restored in both groups. MAP increased close to the baseline during the early resuscitation period and decreased slowly during follow-up. Oxygen delivery remained at 46% of baseline, whereas systemic oxygen consumption was restored during resuscitation in both groups. Liver tissue oxygen tension increased well above baseline during resuscitation in the dopexamine group, and liver tissue oxygen tension was significantly higher than in the control group. After 60 mins of resuscitation, the liver oxygen tension decreased to control group values. None of the other tissue oxygen tensions showed any differences between groups.
Dopexamine administration during crystalloid resuscitation from hemorrhagic shock was well tolerated and resulted in significant and specific, although transient, improvement in liver oxygenation.
评估在失血性休克晶体液复苏过程中使用多培沙明对血流动力学变量和组织氧张力的影响。
随机对照试验。
大学中心的动物实验室。
12头仔猪，平均体重22千克。
动物麻醉后放血至失血性休克状态，然后使用晶体液以约2.6毫升/分钟/千克的速率输注进行复苏（总量208毫升/千克）。在复苏的20至30分钟期间以及直至复苏开始后80分钟的随访期间，测量心输出量和平均动脉压（MAP）作为容量填充指标。从容量替代开始时以6微克/千克·分钟的速率输注多培沙明（多培沙明组，n = 6）。其余动物（对照组，n = 6）仅给予容量替代。
计算全身氧输送变量。通过肝脏、结膜层以及腹部皮下和经皮电极连续记录组织氧张力。休克期间MAP从119±2（SEM）降至44±2毫米汞柱，心输出量减少77%。复苏期间，两组的心输出量均恢复。复苏早期MAP接近基线水平升高，随访期间缓慢下降。氧输送维持在基线的46%，而两组复苏期间全身氧消耗均恢复。多培沙明组复苏期间肝脏组织氧张力升高至基线以上，且肝脏组织氧张力显著高于对照组。复苏60分钟后，肝脏氧张力降至对照组水平。其他组织氧张力在两组之间未显示任何差异。
在失血性休克晶体液复苏过程中使用多培沙明耐受性良好，尽管是短暂的，但能显著且特异性地改善肝脏氧合。
