经气道滴注肾上腺素对循环系统的作用及其干预

Epinephrine＇s circulatory side effects and intervention instilling through airway

目的 肾上腺素气道内滴注被相关指南推荐作为处理肺活检并发出血的方法,本文拟探索经气道滴注肾上腺素后引起循环系统副作用的机制,同时采用白蛋白干预肾上腺素的局部吸收,以探索减轻肾上腺素循环系统副作用的方法.方法 将市购15只公猫随机平均分为白蛋白＋肾上腺素组、肾上腺素组和生理盐水对照组,分别经支气管给予肾上腺素混合白蛋白、肾上腺素混合生理盐水和单纯生理盐水,并于注药前、0.5、1、1.5、2、3、5、10、15、30、60、90、120 min时测量有创血压、心率和血浆肾上腺素浓度.结果 白蛋白＋肾上腺素组收缩压从（190±16） mmHg（1 mmHg=0.133 kPa）升高到（198±11）mmHg,心率升高了2.72％,血浆肾上腺素浓度从0.28 ng/ml升高到6.95 ng/ml;肾上腺素组收缩压从（181±17） mmHg升高到（206±18） mmHg,心率升高了11.48％,血浆肾上腺素浓度从0.34 ng/ml升高到8.50 ng/ml;生理盐水对照组收缩压从（205 ± 24） mmHg降低到（181±24） mmHg,心率升高了6.87％,血浆肾上腺素浓度从0.28 ng/ml升高到0.65 ng/ml,心率和收缩压变化趋势白蛋白＋肾上腺素组和生理盐水对照组差异没有统计学意义,白蛋白＋肾上腺素组和肾上腺素组、肾上腺素组和生理盐水对照组差异有统计学意义,血浆肾上腺素浓度变化趋势三组两两之间差异有统计学意义.结论 经外周气道应用肾上腺素后可以导致血压升高、心率增快的副作用;混合白蛋白后可以通过影响肾上腺素经气道吸收,而减轻肾上腺素经气道应用后的循环系统副作用.

Objective Epinephrine instilling through peripheral airway in bronchoscope was recommended by guideline for hemostasis.We explored the mechanism of the circulatory system side effects by epinephrine absorbing through airway and the way to alleviate the epinephrine＇ s circulatory side effects by blending albumin.Methods A total of 15 adult male cats were divided averagely and randomly into three groups.Group albumin ＋ epinephrine,Group epinephrine and Group saline were instilled into bronchia by epinephrine admixed of albumin,saline or saline alone.Invasive blood pressure and heart rate and concentration of epinephrine were recorded before administration,and at points of the 30th second,60th second,90th second,3rd minute,5th minute,10th minute,15th minute,30th minute,60th minute,90th minute and 120th minute after administration.Results In Group albumin ＋ epinephrine the increased range of systolic blood pressure and heart rate and concentration of epinephrine were 4.75％ and 2.72％ and 6.67ng/ml;in Group saline ＋ epinephrine were 13.90％ and 11.48％ and 8.16ng/ml;in Group saline systolic blood pressure decreased 12.11％ and heart rate and concentration of epinephrine increased 6.87 ％ and 0.37 ng/ml.The tendency of variation of systolic blood pressure and heart rate had statistic difference between Group albumin ＋ epinephrine and Group saline ＋ epinephrine,between Group saline ＋ epinephrine and Group saline.The tendency of variation of concentration of epinephrine had statistic difference among three groups.Conclusion Epinephrine instilling through peripheral airway can cause the circulatory system side effects;blending Albumin can alleviate the epinephrine＇ s circulatory side effects by decreasing the absorption through Airway.