后叶加压素对新生儿心肺复苏过程中窒息仔猪脑和心脏组织的影响。

IF 2.1 Q3 CRITICAL CARE MEDICINE
Ali Chaudhry , Megan O’Reilly , Marwa Ramsie , Tze-Fun Lee , Po-Yin Cheung , Georg M. Schmölzer
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引用次数: 0

摘要

背景:根据科学和治疗建议的共识,肾上腺素是目前唯一被推荐用于新生儿心肺复苏(CPR)的心脏复苏药物。一种替代药物,抗利尿激素,可能是有益的,然而,关于其对新生儿心肺复苏术恢复后心脏和脑组织的影响的数据有限。目的:比较过渡期窒息仔猪复苏过程中加压素和肾上腺素对心脏和脑组织损伤的影响。方法:新生仔猪(10只/组)麻醉、气管切开、插管、插管、缺氧、窒息、心脏骤停。仔猪在心肺复苏术中随机分配静脉注射抗利尿激素(Vaso, 0.4 U/kg)或肾上腺素(Epi, 0.02 mg/kg),直至恢复自然循环(ROSC)。从ROSC后存活4小时的仔猪的脑组织中采集左心室心脏组织、大脑额顶叶皮层和丘脑样本。测定组织匀浆中促炎细胞因子白介素(IL)-1β、IL-6、IL-8、肿瘤坏死因子(TNF)-α、心肌肌钙蛋白-1、乳酸的浓度以及氧化谷胱甘肽和总谷胱甘肽的水平。主要结果:Vaso组至ROSC的中位时间(IQR)为127 (98-162)sec, Epi组为197 (117-480)sec (p = 0.07)。Vaso组的ROSC率为10/10 (100%),Epi组为7/10 (70%)(p = 0.21);Vaso组至ROSC后4小时的生存率为10/10 (100%),Epi组为5/7 (71%)(p = 0.15)。Kaplan-Meier生存曲线组间差异有统计学意义(p = 0.011)。Vaso组心肌组织IL-8浓度显著低于Epi组(16.9 (2.94)pg/mg vs. 33.0 (6.75)pg/mg, p = 0.026)。在Vaso组和Epi组之间,心脏和脑组织损伤的其他指标相似。结论:与肾上腺素相比,加压素对窒息新生仔猪的复苏是有效的,并且与心肌炎症的减少有关,并且没有证据表明大脑额顶叶皮层和丘脑区域的组织损伤增加。加压素可能是新生儿心肺复苏术中肾上腺素的可行替代品,但需要进一步的研究。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Effect of vasopressin on brain and cardiac tissue during neonatal cardiopulmonary resuscitation of asphyxiated post-transitional piglets

Background

Epinephrine is currently the only recommended cardio-resuscitative medication for use in neonatal cardiopulmonary resuscitation (CPR), as per consensus of science and treatment recommendations. An alternative medication, vasopressin, may be beneficial, however there is limited data regarding its effect on cardiac and brain tissue following recovery from neonatal CPR.

Aim

To compare the effects of vasopressin and epinephrine during resuscitation of asphyxiated post-transitional piglets on cardiac and brain tissue injury.

Methods

Newborn piglets (n = 10/group) were anesthetized, tracheotomized and intubated, instrumented, and exposed to hypoxia-asphyxia and cardiac arrest. Piglets were randomly allocated to receive intravenous vasopressin (Vaso, 0.4 U/kg) or epinephrine (Epi, 0.02 mg/kg) during CPR until return of spontaneous circulation (ROSC). Left ventricle cardiac tissue, and frontoparietal cerebral cortex and thalamus samples from brain tissue were collected from piglets that survived four hours after ROSC. The concentrations of the pro-inflammatory cytokines interleukin (IL)-1β, IL-6, IL-8, and tumour necrosis factor (TNF)-α, cardiac troponin-1, lactate, and levels of oxidized and total glutathione were quantified in tissue homogenates.

Main Results

The median time (IQR) to ROSC was 127 (98–162)sec with Vaso and 197 (117–480)sec with Epi (p = 0.07). ROSC rate was 10/10 (100 %) with Vaso and 7/10 (70 %) with Epi (p = 0.21); survival to four hours after ROSC was 10/10 (100 %) with Vaso and 5/7 (71 %) with Epi (p = 0.15). Kaplan-Meier survival curves were significantly different between groups (p = 0.011). Cardiac tissue IL-8 concentration was significantly lower with Vaso than Epi (16.9 (2.94)pg/mg vs. 33.0 (6.75)pg/mg, p = 0.026). All other markers of cardiac and brain tissue injury were similar between Vaso and Epi groups.

Conclusions

Vasopressin is effective in the resuscitation of asphyxiated newborn piglets and is associated with reduced inflammation of the myocardium compared to epinephrine, and there was no evidence of increased tissue injury in the frontoparietal cortex and thalamus regions of the brain. Vasopressin might be a viable alternative to epinephrine during neonatal CPR, but further studies are warranted.
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来源期刊
Resuscitation plus
Resuscitation plus Critical Care and Intensive Care Medicine, Emergency Medicine
CiteScore
3.00
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