Noradrenalin effectively rescues mice from blast lung injury caused by laser-induced shock waves.
Noradrenalin effectively rescues mice from blast lung injury caused by laser-induced shock waves.
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DOI：
10.1186/s40635-015-0069-7
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发表时间：
2015-12
影响因子：
3.5
通讯作者：
Sakamoto T
中科院分区：
文献类型：
--
作者：
Miyawaki H;Saitoh D;Hagisawa K;Noguchi M;Sato S;Kinoshita M;Miyazaki H;Satoh Y;Harada N;Sakamoto T
由冲击波引起的冲击性肺损伤（BLI）在院前环境中是极其严重的，低血压被认为是这种情况下死亡的主要原因。本研究旨在阐明使用激光诱导冲击波（LISW）的严重BLI的病理生理学，并确定初始治疗。目前的调查包括两个部分。对于验证研究，将小鼠随机分配至接受1.2、1.3或1.4 J/cm 2 LISW单次注射至双肺的组中。监测存活率、收缩压（sBP）、心率（HR）、外周血氧饱和度（SpO 2）和休克指数（shock index），并观察肺组织病理学变化。该研究评价了如下的儿茶酚胺的作用。随机分配的小鼠接受1.4 J/cm 2 LISW，随后立即腹腔内给予多巴酚丁胺、去甲肾上腺素或生理盐水。主要结局是生存率。此外，在LISW前和LISW后5和10 min测定sBP、HR、SpO 2和休克指数，并在LISW前和LISW后1 min测定心输出量、左心室射血分数和体循环血管阻力（SVR）。LISW后立即出现BLI三联征（低血压、心动过缓和低氧血症）。随着LISW剂量的增加，存活率恶化（1.2 J/cm 2为100%，1.3 J/cm 2为60%，1.4 J/cm 2为10%）。组织病理学结果与人BLI的结果一致。LISW高剂量组（1.4 J/cm 2）的存活率在接受去甲肾上腺素的组中最高（100%），SVR值显著升高（从565到1451 dyn s/min 5）。相反，多巴酚丁胺组和生理盐水组的存活率分别为40%和10%，两组的SVR值在LISW后均无显著变化。在严重BLI的初始阶段死亡的主要原因是由于缺乏外周血管收缩引起的低血压。因此，在严重BLI的初始阶段，立即给予去甲肾上腺素可能是有效的治疗方法。
Blast lung injuries (BLI) caused by blast waves are extremely critical in the prehospital setting, and hypotension is thought to be the main cause of death in such cases. The present study aimed to elucidate the pathophysiology of severe BLI using laser-induced shock wave (LISW) and identify the initial treatment. The current investigation comprised two parts. For the validation study, mice were randomly allocated to groups that received a single shot of 1.2, 1.3, or 1.4 J/cm2 LISW to both lungs. The survival rates, systolic blood pressure (sBP), heart rate (HR), peripheral oxyhemoglobin saturation (SpO2), and shock index were monitored for 60 min, and lung tissues were analyzed histopathologically. The study evaluated the effects of catecholamines as follows. Randomly assigned mice received 1.4 J/cm2 LISW followed by the immediate intraperitoneal administration of dobutamine, noradrenalin, or normal saline. The primary outcome was the survival rate. Additionally, sBP, HR, SpO2, and the shock index were measured before and 5 and 10 min after LISW, and the cardiac output, left ventricular ejection fraction, and systemic vascular resistance (SVR) were determined before and 1 min after LISW. The triad of BLI (hypotension, bradycardia, and hypoxemia) was evident immediately after LISW. The survival rates worsened with increasing doses of LISW (100 % in 1.2 J/cm2 vs. 60 % in 1.3 J/cm2, 10 % in 1.4 J/cm2). The histopathological findings were compatible with those of human BLI. The survival rate in LISW high group (1.4 J/cm2) was highest in the group that received noradrenalin (100 %), with significantly elevated SVR values (from 565 to 1451 dyn s/min5). In contrast, the survival rates in the dobutamine and normal saline groups were 40 and 10 %, respectively, and the SVR values did not change significantly after LISW in either group. The main cause of death during the initial phase of severe BLI is hypotension due to the absence of peripheral vasoconstriction. Therefore, the immediate administration of noradrenalin may be an effective treatment during the initial phase of severe BLI.