早期微量泵控制输注去甲肾上腺素对失血性休克兔血流动力学和心肌功能的影响

Efficacy of Early Micro-pump Norepinephrine Infusion on Hemodynamics and Myocardial Functions of Hemorrhagic Shock Rabbit

目的:探讨失血性休克早期微量泵控制输注去甲肾上腺素,对家兔血流动力学、心肌和心功能的影响。方法:实验采用健康成年新西兰兔,随机分为失血性休克去甲肾上腺素治疗组(NE组,n=7)和失血性休克生理盐水治疗组(NS组,n=7);股动脉放血法制备失血性休克模型成功后,NE组立即给予10min去甲肾上腺素的微量泵泵入,速度为0.2-1mg/(kg·h),同时静脉输注与丢失血量等量的生理盐水;NS组立即给予10min生理盐水补液治疗,补液量为3倍的丢失血量,同样采取微量泵匀速补液。10min强化治疗结束,记录为0h。随后维持并记录0,0.5,1,2,4h各时间点血流动力学指标,并留取血清进行心肌酶学(CK和CKMB)和肌钙蛋白(cTnI)分析。结果:NE组较NS组心率明显提高;NS仅在治疗前期(0h和1h)改善平均动脉压(MAP),NE则可在各时间点持续有效改善MAP;NE在一定的使用时程内(0-2h)可改善失血性休克动物的左室平均压(LVAP);NE较NS可明显提升失血性休克的左心室收缩功能;NE较NS从0.5h起可明显改善左心室舒张功能;心肌酶学和TnI结果显示NE组与NS组整体存在明显差异:CK[(23.87±16.85)vs.(13.22±2.50)ng/ml,P<0.05],CKMB[(8.80±5.68)vs.(5.27±1.14)ng/ml,P<0.05]和cTnI[(109.09±37.81)vs.(84.87±10.73)pg/ml,P<0.05]。结论:早期微量泵控制给予去甲肾上腺素治疗失血性休克,有助于改善早期血流动力学和心功能指标,但可能增加失血性休克心肌的损伤。

Objective：To explore the efficacy of early immediate micro-pump administration of vasoactive agent on the hemodynamics,myocardium and cardiac function of hemorrhagic shock rabbit.Methods：Healthy adult New Zealand rabbits were randomly divided into hemorrhagic shock ＋norepinephrine group（NE group,n=7）and hemorrhagic shock ＋ normal saline group（NS group,n=7）.After that rabbits were exsangninated from femoral artery to develop the model of hemorrhagic shock,norepinephrine infusion through micro-pump（0.2-1mg/[kg·h]）was im-mediately injected for 10 minutes for an intensive treatment,together with normal saline infusion of the same volume as lost blood in the NE group.In the NS group,during the first 10 minutes,we only gave the normal saline infusion by micro-pump with constant speed,and the volume was3 times of lost blood.After 10minutes＇ intensive treatment,the result was labeled as 0h.Subsequently,the treatment was to maintain the hemodynamic indicators and the values would be recorded at 0,0.5,1,2and 4h.The blood sample would be withdrawn at each time point for myocardial enzyme and troponin analysis.Results：Heart rate significantly increased in the NE group.MAP could only be meliorated at early stage（0to 1h）in the NS group,but in the NE group,it was improved continuously at each time point.LVAP could be improved during the early period of experiment（0to 2h）in the NE group.Compared with NS group,the left ventricular systolic function in the NE group significantly enhanced,the diastolic function also significantly improved from 0.5to 4h.The results of CK,CK-MB and TnI showed significant differences between NE group and NS group：CK（[23.87±16.85]vs.[13.22±2.50]ng/ml,P0.05）,CKMB（[8.80±5.68]vs.[5.27±1.14]ng/ml,P0.05）and cTnI（[109.09±37.81]vs.[84.87±10.73]pg/ml,P0.05）.Conclusion：Early micro-pump norepinephrine infusion on hemorrhagic shock could help maintain and improve ealy hemodynamics and myocardial functions,however,NE may cause damage to myocardium in hemorrhagic shock.