Hemodynamic effects of epinephrine, bicarbonate and calcium in the early postnatal period in a lamb model of single-ventricle physiology created in utero.
Hemodynamic effects of epinephrine, bicarbonate and calcium in the early postnatal period in a lamb model of single-ventricle physiology created in utero.
复制标题
肾上腺素、碳酸氢盐和钙在产后早期对子宫内创建的单心室生理学羔羊模型的血流动力学影响。
DOI：
10.1016/s0735-1097(96)00413-5
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发表时间：
1996
期刊：
影响因子：
--
通讯作者：
Hanley,FL
中科院分区：
文献类型：
--
作者：
Reddy,VM;Liddicoat,JR;McElhinney,DB;Fineman,JR;Klein,JR;Chang,R;Hanley,FL
ObjectivesA可重复的单心室生理学的胎儿动物模型被创建来检查通常用于单心室患者围产期和围手术期重症监护管理中的药物的效果。BackgroundSingle-ventricular生理学的特征在于平行的肺循环和体循环，肺和体循环床的相对阻力决定了每个循环的有效血流量。这些患者的围产期和围手术期管理主要基于经验观察，并且在机构之间差异很大，并且由于新生儿的过渡生理而进一步复杂化。缺乏单心室生理学的动物模型阻碍了对这个问题的理解。MethodsA 10 mm，Damus-Kaye-Stansel-型腹主动脉吻合在10只胎羊在140±1.2天的妊娠。远端结扎主肺动脉，并通过5 mm的肺动脉分流管提供肺血流量（Qp）。8只羔羊足月分娩，出生后48至72小时进行心肺转流（30分钟）。在转流前和转流后进行药物干预（肾上腺素0.1Mg/kg体重/min，碳酸氢钠2 mEq/kg，氯化钙10 mg/kg），观察血流动力学反应。仅在postbypass study. ResultsBefore和after旁路，肾上腺素输注和钙和碳酸氢盐管理增加QP和全身血流量（Qs）（总心输出量），但产生的QP/Qs比（-0.5%至-7.3%变化）只有很小的变化，肾上腺素推注的反应。随着肾上腺素推注，Qp极大地增加，Qp/Qs比率增加了584%（p < 0.001）.ConclusionsIn neonatal lamps with single ventricular physiology created in utero，肾上腺素输注和钙和碳酸氢盐给药增加了总心输出量，而没有显着损害Qp/Qs比率。然而，肾上腺素推注似乎在单心室生理情况下对血流动力学有害，应谨慎使用，在单心室生理患者的复苏中可能以相对较低的剂量使用。进一步研究剂量依赖性效应和延长常用药物给药的效应，将有助于更好地管理单心室生理学患者。
ObjectivesA reproducible fetal animal model of single-ventricle physiology was created to examine the effects of pharmacologic agents commonly used in the perinatal and perioperative intensive care management of patients with a single ventricle.BackgroundSingle-ventricle physiology is characterized by parallel pulmonary and systemic circulations, with effective blood flow to each determined by the relative resistances in the pulmonary and systemic vascular beds. Perinatal and perioperative management of these patients is largely based on empiric observations and differs considerably between institutions and is further complicated by the transitional physiology of the newborn. The lack of animal models of single-ventricle physiology has hindered the understanding of this problem.MethodsA 10-mm, Damus-Kaye-Stansel-type aortopulmonary anastomosis was created in 10 fetal sheep at 140±1.2 days of gestation. The main pulmonary artery was ligated distally, and pulmonary blood flow (Qp) was provided through a 5-mm aortopulmonary shunt. Eight lambs were delivered at term and placed on cardiopulmonary bypass (30 min) 48 to 72h after birth. Pharmacologic interventions (0.1Mg/kg body weight per min of epinephrine, 2mEq/kg of sodium bicarbonate and 10mg/kg of calcium chloride) were performed before and after bypass, and hemodynamic responses were observed. The response to the epinephrine bolus was determined only in the postbypass study.ResultsBoth before and after bypass, epinephrine infusion and calcium and bicarbonate administration increased Qp and systemic blood flow (Qs) (total cardiac output) but produced only small changes in the Qp/Qs ratio (-0.5% to -7.3% change). With the epinephrine bolus, Qp increased enormously, and the Qp/Qs ratio increased by 584% (p < 0.001).ConclusionsIn neonatal lambs with single-ventricle physiology created in utero, epinephrine infusion and calcium and bicarbonate administration increased total cardiac output without significantly compromising the Qp/Qs ratio. However, epinephrine bolus seems to be hemodynamically detrimental in circumstances of single-ventricle physiology and should be used with caution and probably in relatively lower doses in the resuscitation of patients with single-ventricle physiology. Further investigation of the dose-dependent effects and the effects of prolonged administration of common pharmacologic agents will enable better management of patients with single-ventricle physiology.