在心肺复苏期间是否禁用上腺素?
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
概括
在心肺复苏 (CPR) 过程中,上腺素通过增加肺内转移和降低氧和,使肺气交换恶化. 甲索克萨明提供类似的压力效应,但没有这些不良的肺部影响.
科学领域:
- 心肺生理学 心肺生理学
- 药理学 药理学是指药理学的学科.
- 临界护理医学 临界护理医学
背景情况:
- 在心肺复苏 (CPR) 期间服用上腺素后,肺气交换障碍尚不清楚.
- 上腺素在复苏期间改变肺功能中的作用需要进一步调查.
研究的目的:
- 为了研究上腺素在实验室动和心肺复苏过程中对肺气交换的影响.
- 为了比较上腺素与甲索胺 (一种缺乏β-上腺素活性的压力剂) 对心肺复苏过程中的气体交换的影响.
主要方法:
- 被麻醉的猪经历了诱导心室动和心肺复苏.
- 使用惰性气体的输入来通过多重惰性气体消除技术来确定通风 perfusion (VA/Q) 分布.
- 测量包括心脏输出量,血压,pH值和在注射盐水,上腺素或甲索胺后的动脉氧和度.
主要成果:
- 心室动和心肺复苏显著降低了心脏输出,血压和pH.
- 上腺素的使用导致肺内冲路的显著增加 (大约比盐水多300%) 和动脉氧和度 (SaO2) 的显著降低.
- 甲索克萨明增加了平静血压类似于上腺素,但没有恶化肺内转移或SaO2.
结论:
- 上腺素显著增加肺内转移并减少SaO2在心肺复苏期间,可能通过减轻低氧性肺血管收缩由于其β-上腺素活性.
- 甲索胺是CPR的有效压力剂,不会引起与上腺素所见的有害的肺气交换异常.
- 建议考虑在心肺复苏治疗中使用美托克萨或类似的药物,而不是上腺素,以改善结果.
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