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目的观察去甲肾上腺素(NE)治疗感染性休克过程中对肺血管压力的影响。方法选取健康成年杂种犬12只,随机分为对照组(n=5,注射生理盐水1 mL/kg)和内毒素组(n=7,静脉注射脂多糖1 mg/kg)。当体循环收缩压下降幅度达给药前基础值的40%以上,两组分别给予NE0.5、1.0、2.0和5μg·kg-1·min-1,每个剂量给药间隔>10 min。观察两组肺动脉压(PAP)、肺静脉压(PVP)和体动脉压(SAP)的变化,分析两组间的差异和相互关系。结果对照组给药前后PAP无显著变化(P>0.05),在给予NE 2.0和5.0μg·kg-1·min-1后PVP较给药前显著增加(P<0.05),在给予1.0、2.0和5.0μg·kg-1·min-1后SAP较给药前明显升高(P<0.01)。内毒素组PAP在给予NE 2.0和5.0μg·kg-1·min-1后较给药前显著增加(P<0.05),PVP在给药前后无显著变化(P>0.05),在给予NE 1.0、2.0和5.0μg·kg-1·min-1SAP较给药前显著升高(P<0.05)。给予NE1.0、2.0和5.0μg·kg-1·min-1时两组SAP有显著差异(P<0.05),PAP和PVP组间比较均无显著差异(P>0.05)。对照组PVP/SAP和PAP/SAP比值在给药前后无显著变化(P>0.05)。内毒素组PVP/SAP和PAP/SAP比值较给予内毒素前明显增加(P<0.05),在给予NE 2.0和5.0μg·kg-1·min-1后较给药前略有降低(P<0.05)。结论感染性休克时给予NE不引起肺静脉血管张力增加,给予NE剂量达到2.0和5.0μg·kg-1·min-1将引起PAP和SAP增加,但PAP升高幅度低于SAP升高幅度。
Objective To observe the effect of norepinephrine (NE) on pulmonary vascular pressure in the treatment of septic shock. Methods Twelve healthy adult dogs were randomly divided into control group (n = 5, normal saline 1 mL / kg) and endotoxin group (n = 7, intravenous injection of lipopolysaccharide 1 mg / kg). When systemic systolic blood pressure decreased by more than 40% of the baseline value before treatment, the two groups were given NE 0.5, 1.0, 2.0 and 5 μg · kg-1 · min-1, respectively, and each dose interval was> 10 min. The changes of pulmonary arterial pressure (PAP), pulmonary venous pressure (PVP) and arterial pressure (SAP) were observed. The differences and correlation between the two groups were analyzed. Results There was no significant change in PAP before and after administration (P> 0.05). After administration of NE 2.0 and 5.0 μg · kg-1 · min-1, PVP significantly increased (P <0.05) And 5.0μg · kg-1 · min-1 SAP significantly increased (P <0.01). The PAP in endotoxin group was significantly increased (P <0.05) before and after administration of NE 2.0 and 5.0 μg · kg -1 · min -1, and PVP had no significant change before and after administration (P> 0.05) , 2.0 and 5.0μg · kg-1 · min-1SAP were significantly higher than those before administration (P <0.05). The levels of SAP in both groups were significantly different (P <0.05), but there was no significant difference between PAP and PVP groups (P> 0.05). The PVP / SAP and PAP / SAP ratio in the control group had no significant changes before and after administration (P> 0.05). The ratio of PVP / SAP and PAP / SAP in endotoxin group was significantly higher than that before endotoxin treatment (P <0.05), but slightly decreased after administration of NE 2.0 and 5.0 μg · kg-1 · min-1 ). Conclusions Administration of NE at septic shock did not induce an increase in pulmonary vascular tone. Increasing PAP and SAP by 2.0 and 5.0 μg · kg-1 · min-1 doses of NE resulted in an increase of PAP less than that of SAP.