Effects of Dobutamine, Epinephrine and Norepinephrine on the Hemodynamics of Dogs during Hemorrhagic Shock

Dobutamine、Epinephrine及Norepinephrine於狗發生出血性休克時其對血行動力學之比較

羅霞(Xia Luo) ； 黃宇光(Yuguang Huang) ； John K. Hayes ； 黃光中(K.C. Wong) ； James B. Yee ； Scott McJames

《Acta Anaesthesiologica Sinica》 35卷2期 (1997/06) Pp. 61-71

摘要

Background: The present study examined how effective epinephrine (EPI), norepinephrine (NOR) and dobutamine (DOB) were for resuscitating dogs subjected to hemorrhagic shock (HS). Methods: Dogs (n = 42) were randomly assigned to seven test groups: EPI, NOR and DOB infusion with and without HS, and HS dogs with no catecholamine. Following baseline measurements, the dogs were bled to a mean arterial blood pressure of 40 mmHg. After 3 h, the shed blood was reinfused. EPI and NOR (0.1, 0.4 and 1.6 μg/kg/min) and DOB (2.5, 5.0 and 10.0 μg/kg/min) were given and the dog allowed to stabilize for 30 min. Hemodynamic and blood gas data were obtained at 6 time points (control, shock, resuscitation and after catecholamine infusion). Results: There was no significant difference in myocardial performance (dP/dt) between the respective shocked and unshocked groups after blood resuscitation. In dogs without catecholamine infusion, CO and SvO_2 continued to decline whereas SVR increased. DOB (2.5 to 10.0 μg/kg/min) with and without shock improved CO, LV dP/dt, SVR and SvO_2. EPI did not further improve CO or SvO_2 at infusion rates above 0.1 μg/kg/min (with and without shock). NOR did not improve SvO_2 at any infusion rate (with and without shock) and did not improve CO until the infusion rate was at 0.4 μg/kg/min (without shock). Conclusions: This study advocates the use of both volume replacement therapy and DOB for resuscitation of HS dogs.

關鍵字

Shock: hemorrhagic ； Catecholamines: dobutamine, epinephrine, norepinephrine ； Hemodynamics: cardiac output

並列摘要

背景：本研究是關於epinephrine（EPI）,norepinephrine（NOR）,and dobutamine（DOB）用於出血性休克的狗時的復蘇效果。方法：42條狗隨機分為七組：分別為對照組及休克組接受DOB, EPI, NOR及休克有藥物輸注組。在動物基礎值穩定後，通過股動脈放血，使狗血壓處於40 mmHg，並維持此值達三小時，之後將放出出的血再輸入狗體內，三十分鐘分別輸注DOB（2.5, 5, 10 μg/kg/min）、NOR或EPI（0.1, 0.4, 1.6 μg /kg/min）。記錄血液動力學和血氣分析值共六次：基礎值，休克，復蘇和藥物輸注（三個劑量）。結果：心肌收縮力（以dP/dt顯示）在對照組和休克組有明顯差異。心輸出量（CO）和靜脈混合血氧飽和度（SvO_2）持續下降，同時全身血管阻力（SVR）不斷升高。輸注DOB能顯著增加CO, dP/dt，和SvO_2）並降低SVR值（對照和休克組）。EPI只升高CO和SvO_2當其濃度≤0.4μg/kg/min時。NOR不增加SvO_2（休克和對照組），且只增加對照組CO於其濃度為0.4 mg/kg/min時。結論：研究表明，結合輸血擴充容量和DOB藥物支持用於狗出血性休克為較好的復蘇措施。

並列關鍵字

休克：出血性 ； 兒茶酚胺類：腎上腺素，正腎上腺素 ； 血流動力學：心輸出量