Ｂｙ ｐｅｒｆｕｓｉｎｇ ｌｉｖｅｒｓ ｆｒｏｍ Ｗｉｓｔａｒ ｒａｔｓ ｒｅｎｄｅｒｅｄ ｓｅｐｓｉｓ ｗｉｔｈ ａｃｕｔｅ ｏｂｓｔｒｕｃｔｉｖｅ ｃｈｏｌａｎｇｉｔｉｓ（ＡＯＣ）ｉｎ ｖｉｔｒｏ ｉｎ ａ ｎｏｎｒｅｃｉｒｃｕｌａｔｉｎｇ ｍｏｄｅ，ｗｅ ｍｅａｓｕｒｅｄ ｔｈｅ ｒａｔｅｓ ｏｆ ｇｌｕｃｏｎｅｏｇｅｎｅｓｉｓ ｆｒｏｍ ｓａｔｕｒａｔｉｎｇ ｃｏｎｃｅｎｔｒａｔｉｏｎ ｏｆ ｌａｃｔａｔｅ （５ ｍｍｏｌ／L) ｐｌｕｓ ｐｙｒｕｖａｔｅ （０５ ｍｍｏｌ／Ｌ） ａｎｄ ｔｈｅ ｒｅｓｐｏｎｓｅ ｏｆ ｇｌｕｃｏｎｅｏｇｅｎｅｓｉｓ ｔｏ ｇｌｕｃａｇｏｎ ａｎｄ ｅｐｉｎｅｐｈｒｉｎｅ．Ｗｅ ａｌｓｏ ｓｔｕｄｉｅｄ ｔｈｅ ＡＯＣ ｉｎｄｕｃｅｄ ａｌｔｅｒａｔｉｏｎｓ ｉｎ ｔｈｅ ｍｉｌｉｅｕ ｏｆ ｇｌｕｃｏｎｅｏｇｅｎｉｃ （ｇｌｕｃａｇｏｎ，ｅｐｉｎｅｐｈｒｉｎｅ ａｎｄ ｃｏｒｔｉｓｏｌ） ａｎｄ ｃｏｎｔｅｒｒｅｇｕｌａｔｏｒｙ （ｉｎｓｕｌｉｎ） ｈｏｒｍｏｎｅｓ．Ｔｈｅ ｒｅｓｕｌｔｓ ｓｈｏｗｅｄ ｔｈｅ ｒａｔｅ ｏｆ ｇｌｕｃｏｎｅｏｇｅｎｅｓｉｓ ｏｆ ＡＯＣ ２４ ｈ．ｇｒｏｕｐ ｗａｓ ｓｉｇｎｉｆｉｃａｎｔｌｙ ｒｅｄｕｃｅｄ ａｎｄ ｔｈｉｓ ｒｅｄｕｃｔｉｏｎ ｃｏｕｌｄ ｂｅ ｃｏｍｐｅｎｓａｔｅｄ ｂｙ ｉｎｃｒｅａｓｅｓ ｏｆ ｇｌｕｃｏｓｅ ｐｒｅｃｕｒｓｏｒｓ，ｅｓｐｅｃｉａｌｌｙ ｌａｃｔａｔｅ ａｎｄ ｏｆ ｇｌｕｃｏｎｅｏｇｅｎｉｃ ｈｏｒｍｏｎｅｓ ｔｏ ａ ｓｅｒｕｍ ｇｌｕｃｏｓｅ ｌｅｖｅｌ ａｓ ｍｕｃｈ ａｓ ２．５ ｔｉｍｅｓ ｔｈｅ ｎｏｒｍａｌ ｗｈｉｃｈ ｉｓ ｎｅｅｄｅｄ ｉｎ ｓｔｒｅｓｓ ｒｅａｃｔｉｏｎ．Ｔｈｅ ｒａｔｅ ｏｆ ｇｌｕｃｏｎｅｏｇｅｎｅｓｉｓ ｏｆ ＡＯＣ ４８ ｈ．ｗａｓ ｆｕｒｔｈｅｒ ｄｅｃｒｅａｓｅｄ ａｎｄ ｔｈｉｓ ｄｅｃｒｅａｓｅ ｃｏｕｌｄ ｎｏｔ ｂｅ ｃｏｍｐｅｎｓａｔｅｄ ｐｒｏｂａｂｌｙ ａｓ ａ ｒｅｓｕｌｔ ｏｆ ｓｅｖｅｒｅ ｄａｍａｇｅ ｔｏ ｈｅｐａｔｏｃｙｔｅｓ． Ｔｈｅ ｒｅｓｕｌｔｓ ｉｎｄｉｃａｔｅ ｔｈａｔ ｔｈｅ ｒｅｄｕｃｅｄ ｇｌｕｃｏｓｅ ｍｅｔａｂｏｌｉｃ ｒｅｓｐｏｎｓｅ ｄｕｅ ｔｏ ＡＯＣ ｍａｙ ｐｌａｙ ａｎ ｉｍｐｏｒｔａｎｔ ｒｏｌｅ ｉｎ ｔｈｅ ｄｅｖｅｌｏｐｍｅｎｔ ｏｆ ｃｈｏｌａｎｇｉｔｉｓｉｎｄｕｃｅｄ ｄｙｓｆｕｎｃｔｉｏｎ ｏｆ ｍｕｌｔｉｐｌｅ ｏｒｇａｎｓ．
【摘要】 目的 比较靶控诱导后Shikani喉镜、Macintosh直接喉镜和GlideScope®视频喉镜插管时的应激反应。 方法 选取2008年12月-2009年2月期间ASA Ⅰ~Ⅱ级、拟于全身麻醉下行择期颅内占位病变切除术的患者30例，随机分为Shikani喉镜组（S组）、Macintosh直接喉镜组（M组）与GlideScope®视频喉镜组（G组）。靶控异丙酚和瑞芬太尼诱导，分别采用上述3种喉镜行经口气管插管。记录患者的心率、血压，计算心率收缩压乘积（RPP）。 结果 3组插管时间、心率、血压和RPP比较差异无统计学意义（Pgt;0.05）。S组和M组插管后心率、血压及RPP均较插管前显著升高（Plt;0.05），而G组插管后的心率、60~300 s时的收缩压、平均动脉压和RPP与插管前比较，差异无统计学意义（Pgt;0.05）。 结论 3种喉镜进行经口气管插管时具有相似的血流动力学反应，GlideScope®视频喉镜更有利于循环稳定。【Abstract】 Objective To compare the hemodynamic responses of orotracheal intubations with GlideScope® videolaryngoscope, Macintosh direct laryngoscope, and Shikani optical stylet after target-controlled-infusion (TCI). Methods Thirty patients with American Society of Anesthesiologists (ASA) physical status Ⅰ-Ⅱ, scheduled for elective intracranial mass lesion surgery under general anesthesia were randomly allocated equally to Shikani optical stylet group (group S) Macintosh laryngoscope group (group M), and GlideScope® videolaryngoscope group (group G). After the patients became unconscious by TCI induction of propofpol and remifentanil, the endotracheal intubation were carried out through above three laryngoscope. The heart rate (HR), blood pressure and rate pressure product (RPP) were recorded. Results The differences of intubation time, HR, blood pressure and RPP in three groups were not statistically significant (Pgt;0.05). After intubation, the HR, blood pressure and RPP of group S and M were obviously higher than those before intubation (Plt;0.05); while there was no obvious change on the HR, systolic pressure at 60-300 s, mean arterial pressure and RPP of group G compared before intubation (Pgt;0.05). Conclusions There are similar hemodynamic responses in the three laryngoscope. GlideScope® is more advantageous to cycle stability.
ObjectiveTo explore the influence of norepinephrine on the prediction of fluid responsiveness by passive leg raising (PLR) during septic shock. MethodsForty-six septic shock patients in intensive care unit of Nanjing Drum Tower Hospital were prospectively observed from September to November 2012. Among which 36 septic shock patients were enrolled with a positive PLR test (defined by an increase in stroke volume index ≥10%). A PLR test was performed at baseline (PLR1). A second PLR test (PLR2) was performed at returning to supine position for 10 min and the dose of norepinephrine was increased to maintain MAP ≥65 mmHg for 20 min. The changes of heart rate(HR),mean arterial pressure(MAP),central venous pressure(CVP),cardiac index(CI),stroke volume index(SVI),index of systemic vascular resistance(SVRI),global end-diastolic volume index(GEDVI),and cardiac function index(CFI) were monitored by transpulmonary thermodilution technique (PiCCO). ResultsPLR1 significantly increased SVI by (20.54±9.63)%,CI by (20.57±9.89)%,MAP by (7.64±5.77)%,and CVP by (25.83±23.39)%. As the dose of norepinephrine increased,SVI was increased by (16.97±9.06)%,CI by (16.78±8.39)%,GEDVI by (9.08±4.47)%,MAP by (28.07±12.48)%,and CVP by (7.86±8.52)%. PLR2 increased SVI by (13.74±8.79)%,CI by (13.79±9.08)%,MAP by (2.93±5.06)%,and CVP by (13.36±14.74)%. The PLR2 and the dose increase of norepinephrine augmented SVI to a significantly lesser extent than the PLR1 performed at baseline (both P<0.05). However,SVI increased by <10% in 6 patients while the baseline PLR was positive in these patients. ConclusionIn septic patients with a positive PLR at baseline,norepinephrine increases cardiac preload and cardiac output and influences the fluid responsiveness.
ObjectiveTo discuss the effect ofβ2 adrenoceptor on the alveolar fluid clearance (AFC) of the rats with severe acute pancreatitis (SAP). MethodsSD rats was made to SAP model by injecting taurocholate into biliary-pancreatic duct.These rats were randomly divided into sham operation group and SAP group, the SAP group was divided into subgroups of SAP-4 h and SAP-24 h according to the sampling time after making model.The wet-to-dry ratio, AFC, and AFC affected byβ2 adrenoceptor agonist-terbutaline or inhibitor-propranolol were measured in the bilateral lungs.β2 adrenoceptor mRNA expression in the lungs tissues was measured by real-time-PCR. ResultsCompared with the sham operation group, the wet-to-dry ratio was significantly decreased (P < 0.05) and the AFC was significantly increased in the subgroup of SAP-4 h or SAP-24 h (P < 0.05), β2 adrenoceptor agonist-terbutaline couldn't increase the AFC of the subgroup of SAP-4 h or SAP-24 h (P > 0.05), inhibitor-propranolol could decrease AFC of subgroup of SAP-4 h or SAP-24 h (P < 0.05).β2 adrenoceptor mRNA was decreased in the subgroup of SAP-4 h or SAP-24 h as compared with the sham operation group (P < 0.05). ConclusionsBilateral lung liquid volome induced by SAP is less than the normal lung, AFC is increased in the early period of SAP but decreased in the late period.when the lung injury happens, β2 adrenoceptor might modulate AFC in rats of SAP model.The mechanism of lung injury of SAP is so complex that we need more experiments to be done.
ObjectiveTo investigate the influence of norepinephrine on pulmonary vessel pressure in animal model of septic shock. MethodsTwelve health mongrel dogs were randomly divided into a control group (n=5, intravenously injected with normal saline 1 mL/kg) and an endotoxin group(n=7, intravenously injected with lipopolysaccharide 1 mg/kg). When the systemic blood pressure decreased by more than 40% of baseline before administration, the dogs in two groups were intravenously injected with NE 0.5, 1.0, 2.0, 5.0μg·kg-1·min-1. The interval of each dose was more than 10 minutes. The changes of the pulmonary arterial pressure (PAP), pulmonary venous pressure (PVP), and systemic arterial rressure (SAP) were recorded and compared between two groups. ResultsIn the control group, PAP didn't change significantly after administration (P < 0.05), however, PVP increased obviously after NE administration in dose of 2.0 and 5.0μg·kg-1·min-1 (P < 0.05), and SAP increased obviously after NE administration in dose of 1.0, 2.0 and 5.0μg·kg-1·min-1 (P < 0.01). In the endotoxin group, PAP increased obviously after NE administration in dose of 2.0 and 5.0μg·kg-1·min-1 (P < 0.05), while PVP didn't change significantly (P > 0.05), and SAP increased obviously after NE administration in dose of 1.0, 2.0 and 5.0μg·kg-1·min-1 (P < 0.05). There were significant differences in SAP (P < 0.05), not in PAP and PVP (P > 0.05), between two groups after NE administration at dose of 1.0, 2.0 and 5.0μg·kg-1·min-1. The PVP/SAP and PAP/SAP values didn't change significantly after administration in the control group (P > 0.05). In the endotoxin group, the PVP/SAP and PAP/SAP values increased significantly after LPS administration, and decreased slightly after NE administration in dose of 2.0 and 5.0μg·kg-1·min-1 (P < 0.05). ConclusionsNE administration in septic shock can not increase the angiotasis of the pulmonary vein. NE administration in dose of 2.0 and 5.0μg·kg-1·min-1 can cause the increase of PAP and SAP, but the increase of PAP is lower than the increase of SAP.
目的 观察不同浓度肾上腺素与利多卡因混合液头皮浸润注射对开颅术患者血流动力学的影响。方法 选取2010年5月－10月80例颅内肿瘤患者，随机分成4组，行1%利多卡因溶液混合不同浓度的肾上腺素16 mL头皮浸润注射。肾上腺素浓度：A组2.5 μg/mL、B组5.0 μg/mL、C组7.5 μg/mL、D组10.0 μg/mL。记录注射前（T0）、注射后5 min内（T1-10）心率（HR）、平均动脉压（MAP）、收缩压（SBP）、舒张压（DBP），根据各时段的MAP最低值和最高值，计算MAP的降低率和升高率，计数各组MAP下降10%以内、10%～20%和20%以上的例数。 结果 C组的MAP下降例数最多且MAP下降率最高，与其他组间比较差异有统计学意义（P＜0.05）。组内比较，C组MAP、SBP在1.5、2.0、2.5 min时、DBP在2 min时和D组MAP和DBP在1.5、2.0 min时下降差异有统计学意义（P＜0.05）。4组血压下降的同时伴HR增快，但HR组间差异无统计学意义（P＞0.05）。 结论 低浓度的肾上腺素与10%利多卡因混合液用于开颅术患者头皮浸润注射时可导致血压下降。
Objective To systemically review the efficacy and safety of dopamine versus norepinephrine in patients with septic shock. Methods Database searches of MEDLINE, EMbase, Cochrane Controlled Trials Register, VIP, CNKI, and CBM (from the date of database establishment to June 2011) were conducted. Additional studies for collecting relevant data were retrieved via both references of articles and direct contact with authors. Prospectively, randomized controlled trials (RCTs) of dopamine compared with norepinephrine therapy in septic shock patients were selected. The quality of included trials was assessed and relevant data were extracted. Then statistical analysis was performed using RevMan 5.1. Results Nine trials with 3 179 participants were included. The results of meta-analysis showed: compared with norepinephrine, dopamine was associated with a significant 12% elevation in the risk ratio of in-hospital death events of septic shock patients (RR=1.12, 95%CI 1.04 to 1.21, P=0.002). The risk of arrhythmias in dopamine group was 2.63-fold than that in norepinephrine group (RR=2.63, 95%CI 1.51 to 4.55, P=0.000 6). The cardiac index of septic patients in dopamine group was higher than that in norepinephrine group (MD=0.42, 95%CI 0.21 to 0.63, Plt;0.000 1). No significant difference could be found in the heart rate (MD=17.05, 95%CI –0.71 to 34.81, P=0.06) and mean arterial pressure (MD= –0.87, 95%CI –24.97 to 7.62, P=0.30). Conclusion Findings from this meta-analysis suggest that compared with dopamine, norepinephrine significantly reduces both 28-day mortality of septic shock patients and incidence rate of arrhythmias. Norepinephrine is better than dopamine in aspects of efficacy and safety.
ObjectiveTo explore effect of α-adrenoceptor on modulating water of lung in severe acute pancrea-titis (SAP) rat. MethodsThe SD rats were randomly divided into sham operation group (n=5) and SAP group,the SAP group was divided into subgroups of SAP-4 h (n=5) and SAP-24 h (n=5).SAP model was made by injecting taurocholate into bilopancreatic duct.The wet-to-dry ratio,alveolar fluid clearance (AFC),and AFC affected by α1-adrenoceptor inhibitor-prazosin and α2-adrenoceptor inhibitor-yohimbine separately or together were measured in the lungs.The α1-adrenoceptor and α2-adrenoceptor mRNA expressions in the lungs tissues were measured by real-time PCR. Results① The wet-to-dry ratios in the SAP-4 h group and SAP-24 h group were obviously decreased as compared with the sham operation group (P<0.05),which in the SAP-24 h group was significantly lower than that in the SAP-4 h group (P<0.05).② The AFCs in the SAP-4 h group and SAP-24 h group were obviously increased as compared with the sham operation group (P<0.05).The AFCs in the SAP with α1-adrenoceptor inhibitor-prazosin or α2-adrenocpetor inhibitor-yohimbine or prazosin combined with yohimbine were all obviously decreased as compared with the SAP group (P<0.05).③ The α1 adrenoceptor and α2 adrenoceptor mRNAs in the SAP-4 h group and SAP-24 h group were obviously increased as compared with the sham operation group (P<0.05). ConclusionAFC might be modulated by α-adrenoceptor in SAP rat.