エピネフリンは心肺蘇生中に禁忌ですか?
D N Thrush1, J B Downs, R A Smith
1Department of Anesthesiology, University of South Florida College of Medicine, Tampa 33612, USA.
Circulation
|November 14, 1997
まとめ
エピネフリンは,肺内シャントを増加させ,酸素飽和度を低下させることで,心肺蘇生 (CPR) 中の肺ガス交換を悪化させる. メトキサミンは,これらの有害な肺効果なしに,同様の圧縮効果を提供します.
科学分野:
- 心肺生理学 心肺生理学
- 薬理学 薬理学とは
- クリティカルケア・メディシン
背景:
- 心肺蘇生 (CPR) 中のエピネフリン投与後の肺ガス交換障害は十分に理解されていません.
- 蘇生時の肺機能の変化におけるエピネフリンの役割については,さらなる調査が必要である.
研究 の 目的:
- 実験的な心室細動および心肺蘇生時の肺ガス交換に対するエピネフリンの影響を調査する.
- エピネフリンとメトキサミンの効果を比較するために,ベータ-アドレナリン活性を持たない圧力剤であるメトキサミンは,CPR中のガス交換に作用します.
主な方法:
- 麻酔を受けた豚は,誘発性心房細動とCPRを受けた.
- 不活性ガスの注入は,多重不活性ガスの除去技術による換気-貫通 (VA/Q) 分配を決定するために使用されました.
- 測定には,心電量,血圧,pH,および塩分液,エピネフリン,またはメトキサミン投与後の動脈の酸素飽和度が含まれていました.
主要な成果:
- 静脈細動と心肺蘇生は,心臓の出力,血圧,pHを大幅に低下させた.
- エピネフリン投与は,肺内シャントの有意な増加 (塩水よりも約300%多く) と,動脈の酸素飽和度 (SaO2) の顕著な減少をもたらしました.
- メトキサミンはエピネフリンと似たように,ダイアストリック血圧を上昇させたが,肺内シャントやSaO2.2を悪化させなかった.
結論:
- エピネフリンは肺内シャントを著しく増加させ,CPR中にSaO2を減少させ,おそらく,そのベータアドレネルジック活性により低酸素肺血管収縮を弱める.
- メトキサミンは,CPRの効果的な圧縮剤であり,エピネフリンで見られる有害な肺ガス交換異常を引き起こさない.
- CPRのエピネフリンではなくメトキサミンまたは同様の薬剤の検討は,アウトカムを改善するために推奨されます.
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