Remmers D E, Cioffi W G, Bland K I, Wang P, Angele M K, Chaudry I H
Center for Surgical Research and Department of Surgery, Brown University School of Medicine and Rhode Island Hospital, Providence 02903, USA.
Ann Surg. 1998 Jun;227(6):790-9. doi: 10.1097/00000658-199806000-00002.
To determine whether testosterone depletion in males before trauma-hemorrhage has any salutary effects on cardiac performance after hemorrhage and resuscitation.
Studies indicate that castration of male mice before trauma-hemorrhage prevents the immunodepression seen after hemorrhage and resuscitation. However, the effect of precastration on cardiac performance under such conditions remains unknown.
Male rats were castrated or sham-castrated 14 days before the experiment. After laparotomy (i.e., induction of trauma), the rats were bled to and maintained at a mean arterial pressure of 40 mm Hg until 40% of the maximal shed volume was returned in the form of Ringer's lactate solution. The animals were then resuscitated with four times the shed blood volume with Ringer's lactate solution over 60 minutes. Heart performance was measured using a left ventricular catheter connected to an in vivo heart performance analyzer. Indices of left ventricular performance (i.e., maximal rate of the pressure increase [+dP/dt(max)] and decrease [-dP/dt(max)) were measured up to 4 hours after trauma, hemorrhagic shock, and resuscitation.
In sham-castrated animals, trauma-hemorrhage and resuscitation decreased the in vivo heart performance as evidenced by the reduced values of +dP/dt(max) and -dP/dt(max). Precastrated animals, however, showed significantly higher values of +dP/dt(max) and -dP/dt(max) than sham-castrated animals after trauma-hemorrhage and resuscitation.
Testosterone antagonism in males might be an effective approach for maintaining myocardial function after adverse circulatory conditions. Although testosterone depletion in male trauma victims is neither practical nor advocated, testosterone receptor blockade after trauma may represent a novel and useful adjunct for maintaining normal myocardial performance under those conditions.
确定创伤性出血前男性睾酮耗竭对出血及复苏后心脏功能是否有任何有益影响。
研究表明，创伤性出血前对雄性小鼠进行去势可预防出血及复苏后出现的免疫抑制。然而，在此类情况下，去势前对心脏功能的影响仍不清楚。
在实验前14天对雄性大鼠进行去势或假去势。剖腹术后（即诱发创伤），将大鼠放血并维持平均动脉压在40 mmHg，直至以乳酸林格液的形式回输40%的最大放血量。然后在60分钟内用四倍于放血量的乳酸林格液对动物进行复苏。使用连接到体内心脏功能分析仪的左心室导管测量心脏功能。在创伤、失血性休克和复苏后长达4小时内测量左心室功能指标（即压力最大上升速率[+dP/dt(max)]和下降速率[-dP/dt(max)]）。
在假去势动物中，创伤性出血和复苏降低了体内心脏功能，+dP/dt(max)和-dP/dt(max)值降低证明了这一点。然而，去势前的动物在创伤性出血和复苏后，其+dP/dt(max)和-dP/dt(max)值显著高于假去势动物。
男性体内睾酮拮抗可能是在不良循环条件下维持心肌功能的有效方法。虽然对男性创伤受害者进行睾酮耗竭既不实际也不被提倡，但创伤后阻断睾酮受体可能是在这些情况下维持正常心肌功能的一种新的有用辅助手段。
