Is cerebral oxygenation negatively affected by infusion of norepinephrine in healthy subjects?
Is cerebral oxygenation negatively affected by infusion of norepinephrine in healthy subjects?
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DOI：
10.1093/bja/aep065
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发表时间：
2009-06-01
影响因子：
9.8
通讯作者：
Secher, N. H.
中科院分区：
文献类型：
--
作者：
Brassard, P.;Seifert, T.;Secher, N. H.
血管加压剂通常用于增加平均动脉压（MAP），以确保灌注重要器官的压力梯度。去甲肾上腺素对脑氧合的影响尚不清楚。本研究的目的是评估输注去甲肾上腺素对健康受试者脑氧合的影响，在9名健康受试者[6名男性; 26（6）岁，平均（sd）]中输注三种剂量的去甲肾上腺素（0.05、0.1和0.15 μ g kg（-1）min（-1），每次20 min）。MAP、以额叶氧合（Sc-o2）和颈内静脉血氧饱和度（Scr（o2））为特征的脑氧合、大脑中动脉平均流速（MCA Vmean）、心输出量（CO），MAP从88（79-101）[中位数（范围）]升高至115（98-128）随着去甲肾上腺素剂量的增加，总外周阻力增加[20.3（12.2-25.8）至25.2（16.4-28.5）mm Hg min L（-1）; P < 0.05]，因为CO保持在基线值。Sc-o 2和Scr（o 2）随着去甲肾上腺素剂量的增加而降低，在0.1 μ g kg（-1）min（-1）输注去甲肾上腺素时达到统计学显著性[Sc-o 2：78（75-94）to 69（61-83）%; P < 0.05; Scr（o 2）：67（8）to 64（7）%; P < 0.01]。每剂去甲肾上腺素都会降低MCA Vmean [56.9（11.2）至55.0（11.7）cm s（-1）; P < 0.05]，Pa-co2由5.4（0.4）至5.1（0.4）kPa（P < 0.001）。这项研究表明，以0.1 μ g kg（-1）min（-1）或更高的剂量输注去甲肾上腺素可能会对脑氧合产生负面影响。
Vasopressor agents are commonly used to increase mean arterial pressure (MAP) in order to secure a pressure gradient to perfuse vital organs. The influence of norepinephrine on cerebral oxygenation is not clear. The aim of this study was to evaluate the impact of the infusion of norepinephrine on cerebral oxygenation in healthy subjects.Three doses of norepinephrine (0.05, 0.1, and 0.15 mu g kg(-1) min(-1) for 20 min each) were infused in nine healthy subjects [six males; 26 (6) yr, mean (sd)]. MAP, cerebral oxygenation characterized by frontal lobe oxygenation (Sc-o2) and internal jugular venous oxygen saturation (Sjv(o2)), middle cerebral artery mean flow velocity (MCA Vmean), cardiac output (CO), and arterial partial pressure for carbon dioxide (Pa-co2) were evaluated.MAP increased from 88 (79-101) [median (range)] to 115 (98-128) mm Hg with increasing doses of norepinephrine (P < 0.05), reflecting an increase in total peripheral resistance [20.3 (12.2-25.8) to 25.2 (16.4-28.5) mm Hg min litre(-1); P < 0.05] since CO remained at baseline values. Sc-o2 and Sjv(o2) decreased with increasing doses of norepinephrine, reaching statistical significance with norepinephrine infused at 0.1 mu g kg(-1) min(-1) [Sc-o2: 78 (75-94) to 69 (61-83)%; P < 0.05; Sjv(o2): 67 (8) to 64 (7)%; P < 0.01]. MCA Vmean was reduced with each dose of norepinephrine [56.9 (11.2) to 55.0 (11.7) cm s(-1); P < 0.05] and Pa-co2 lowered from 5.4 (0.4) to 5.1 (0.4) kPa (P < 0.001).This study suggests that infusion of norepinephrine at 0.1 mu g kg(-1) min(-1) or higher may negatively affect cerebral oxygenation.