去甲肾上腺素联合左西蒙旦或多巴酚丁胺对脓毒性休克猪的影响

摘要

Objective: To compare the effects of norepinephrine ( NE ) combined with levosimendan ( LEVO ) or dobutamine ( DOB ) in a porcine model of septic shock. Methods: Twelve pigs were anesthetized and mechanically ventilated. Peritonitis model was established via inoculating the autologous feces ( 1g·kg-1) into peritoneal cavity. When mean arterial pressure ( MAP ) decreased to less than 60 mmHg, animals were randomly assigned to receive NE + LEVO0. 4 (μg·kg-1·min-1 LEVO group,n =6) or NE + DOB 10 μg·kg-1·min'K DOB group,n =6) to maintain MAP between 65 and 75 mmHg. Heart rate( HR ), MAP, mean pulmonary artery pressure( MPAP ), CO ( cardiac output), pHa, and plasma levels of lactate ( Lac ), TNF-a, IL-6, IL-10, metabolites of nitric oxide ( Noax ) were measured before model institute ( T1 ) and at shock time ( T2 ), shock 6 h( T3 ), and shock 12 h ( T4 ). Oxygen index ( PaO2/FiO2 ) and oxygen delivery ( DO2 ) were calculated. NE requirements were recorded. Results: There was no significant differences between the two groups with respect to body weight, time to the onset of septic shock, NE requirements, MAP, MPAP, pHa, Lac, CO, IL-10, PaO2/FiO2, and DO2(P>0. 05). Compared with DOB group, LEVO group had lower HR at T3 and T4 , decreased plasma level of TNF-a at T3, and decreased plasma levels of Noax and IL-6 at T4 , respectively ( P <0. 05 ). Conclusion: Compared with NE combined with DOB, NE combined with LEVO can reduce HR and inflammatory responses in a porcine model of septic shock.%目的:比较去甲肾上腺素(NE)联合左西蒙旦(LEVO)或多巴酚丁胺(DOB)对脓毒性休克猪的影响.方法:12只雌性猪麻醉后行气管插管机械通气,取自体粪便(1 g·kg-1)注入腹腔建立腹腔感染模型.当动物平均动脉压(MAP)<60 mmHg时,动物随机均分为NE+LEVO 0-4 μg·kg-1·min-1组(LEVO组,n=6)和NE+DOB 10 μg·kg-1·min-1组(DOB组,n=6).调整NE剂量以维持MAP在65～75 mmHg之间.记录模型建立前(T1)、休克时(T2)、休克后6 h(T3)、休克后12 h(T4)的心率(HR)、MAP、平均肺动脉压(MPAP)、心输出量(CO)、动脉血酸碱值(pHa)、乳酸水平(Lac);计算氧合指数(PaO2/FiO2)及氧输送(DO2);测定血浆中的肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6)、白细胞介素-10(IL-10)、NO代谢产物(NOax);记录NE需要量.结果:两组动物的体重、休克发生时间、NE需要量、MAP、MPAP、pHa、Lac、CO、IL-10、PaO2/FiO2、DO2差异无统计学意义(P>0-05).与DOB组比较,LEVO组T3及T4 HR显著降低(P<0-05),T3时TNF-α及T4时IL-6、NOax水平显著降低(P<0-05).结论:与NE联合DOB相比,NE联合LEVO可降低脓毒性休克猪的HR,减轻炎症反应.