• 1 中國醫(yī)科大學附屬盛京醫(yī)院麻醉科( 遼寧沈陽 110004);;
  • 2 沈陽市骨科醫(yī)院麻醉科( 遼寧沈陽110044);;
  • 3 煤炭總醫(yī)院麻醉科( 北京 100071)通訊作者: 張錦, E-mail: zhangj@ sj-hospital. org;

目的  探討內毒素休克時不同濃度去甲腎上腺素( NE) 和多巴胺( DOPA) 對肺動脈、體動脈血管張力的影響。方法  選用12 只雄性健康大耳白兔。隨機選取6 只白兔制備離體肺動脈環(huán)和體動脈環(huán), 每只制備肺、體動脈環(huán)各6 個, 按肺、體動脈配對分為正常組和LPS 組, 予以NE 干預, 根據(jù)NE 低、中、高劑量再分為三個亞組。其余6 只白兔相同方法制備肺、體動脈血管環(huán), 亦配對分為正常組和LPS 組, 予以DOPA 干預, 根據(jù)DOPA 低、中、高劑量再分為三個亞組。LPS 組血管環(huán)用加入含4 μg/mL LPS 的RPMI 營養(yǎng)液孵育建立內毒素休克模型, 正常組血管環(huán)用RPMI 營養(yǎng)液孵育。通過血管環(huán)張力測定觀察血管環(huán)張力變化。結果  ①在正常組, 低、中劑量NE 和高劑量DOPA 對體動脈的收縮作用均強于肺動脈( P 均 lt;0. 05) , 中劑量DOPA 對體動脈收縮作用弱于肺動脈( P  lt;0. 05) , 高劑量NE 對體、肺動脈收縮作用無顯著差異( P  gt;0. 05) , 低劑量DOPA 對體、肺動脈表現(xiàn)為舒張作用。②LPS 孵育后, 低劑量DOPA 對體動脈的收縮作用弱于肺動脈( P  lt;0. 05) , 低、中、高劑量NE 和中、高劑量DOPA 對體、肺動脈收縮作用均無顯著差異( P 均 gt;0. 05) 。③LPS 孵育后, 與正常對照組比較, NE對體、肺動脈收縮作用減弱或沒有顯著變化; 中劑量DOPA 對體動脈收縮作用增強( P  lt;0. 05) , 對肺動脈收縮作用減弱( P  lt;0. 05) 。結論  內毒組休克時, NE 對體、肺動脈的收縮作用無顯著差異, 中劑量DOPA 可使肺動脈收縮減弱而使體動脈收縮增強。

引用本文： 佟冬怡,張錦,于泓波,李娜,魏會霞. 去甲腎上腺素和多巴胺對內毒素孵育兔肺動脈和體動脈環(huán)張力影響的比較. 中國呼吸與危重監(jiān)護雜志, 2010, 9(2): 188-191. doi: 復制

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1. Varpula M, Tallgren M, Saukkonen K, et al. Hemodynamic variables related to outcome in septic shock. Intensive Care Med, 2005, 31 :1066-1071.
2. Stevens T, Morris K, McMurtry IF, et al. Pulmonary and systemic vascular responsiveness to TNF-alpha in conscious rats. J Appl Physiol, 1993 , 74: 1905-1910.
3. Martin C, Viviand X, Leone M, et al. Effect of norepinephrine on the outcome of septic shock. Crit Care Med, 2000, 28: 2758-2765.
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5. 谷振勇, 凌亦凌, 孟愛宏, 等. 八肽膽囊收縮素對脂多糖誘導離體兔肺動脈反應性變化的影響. 中國病理生理雜志, 1999, 15 :484 -486.
6. Huang XL, Ling YL, Zhu TN, et al. The role of N-acetylcysteine against the injury of pulmonary artery induced by LPS. Chin J Appl Physiol, 2002 , 18: 370 -372.
7. 邢邯英, 凌亦凌, 孟愛宏, 等. 褪黑素改善內毒素血癥大鼠血管反應性. 生理學校, 2005, 57: 367-372.
8. Lee TS, Hou X. Vasoactive effects of ketamine on isolated rabbit pulmonary arteries. Chest, 1995 , 107: 1152-1155.
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10. 朱綠綺. 感染性休克血管活性藥物的應用. 小兒急救醫(yī)學,2004, 11: 77-78 .
11. 索良源, 張錦. 去甲腎上腺素治療感染性休克時對肺靜脈血管阻力的影響. 中國呼吸與危重監(jiān)護雜志, 2009 , 8: 303-306 .
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13. 劉良明, 胡德耀, 陳惠孫, 等. 循環(huán)休克腎上腺素能受體失敏研究進展. 中國病理生理雜志, 1998, 14 : 100-103.
14. Kirkeb en KA, Strand OA. The role of nitric oxide in sepsis--an overview. Acta Anaesthesiol Scand, 1999, 43 : 275-288.
15. Sheridan BC, McIntyre RC Jr, Moore EE, et al. Neutrophils mediate pulmonary vasomotor dysfunction in endotoxin-induced acute lung injury. J Trauma, 1997, 42 : 391-396 .
16. Frostermann U, Pollock JS, Nakane M, et al. Noitric oxide synthases in the cardiovascular system. Trends Cardiovasc Med, 1993, 3 : 104 -110 .
17. 段國辰, 凌亦凌, 谷振勇, 等. 八肽膽囊收縮素對家兔內毒素休克時主動脈及肺動脈反應性改變的影響. 中國急救醫(yī)學, 2002 ,22: 693-697.
18. Atkinson J, Trescases N, Benedek C, et al. Alpha-1 and alpha-2 adrenoceptor agonists induce vasoconstriction of the normotensive ratcaudal artery in vitro by stimulation of a heterogeneous population of alpha-1 adrenoceptors. Naunyn Schmiedebergs Arch Pharmacol,1988, 338 : 529-535.
19. Luke J. Janssen, Hwa Lu-chao, et al. Netherton. Excitationcontraction coupling in pulmonary vascular smooth muscle involves tyrosine kinase and Rho kinase. Am J Physiol Lung Cell Mol Physiol, 2001 , 280: 666-674.
20. 陳瑋, 明佳, 徐競, 等. 內毒素休克后家兔血管反應性的變化規(guī)律及器官差異. 創(chuàng)傷外科雜志, 2008, 10: 456-459 .
21. Hasan A, McDonough KH. The effects of Escherichia coli sepsis and short-term ischemia on coronary vascular reactivity and myocardial function. Shock, 1997, 8: 305 -310.
22. Emmanuele DI, Villa Bianca R, Lippolis L, et al. Dexamethasone improves vascular hyporeactivity induced by lps in vivo by modulating ATP-sensitive potassium channels activity. Br J Pharmacol, 2003 , 140: 91-96 .
23. Boffa JJ, Arendshorst WJ. Maintenance of renal vascular reactivity contributes to acute renal failure during endotoxemic shock. J Am Soc Nephrol, 2005, 16: 117-124.
24. Takakura K, Xiaohong W, Takeuchi K, et al. Deactivation of norepinephrine by peroxynitrite as a new pathogenesis in the hypotension of septic shock. Anesthesiology, 2003 , 98: 928-934.
25. Polak MJ, Drummond WH. Systemic and pulmonary vascular effects of selective dopamine receptor blockade and stimulation in lambs.Pediatr Res, 1993 , 33: 181 -184.
26. Velasco M, Luchsinger A. Dopamine: pharmacologic and therapeutic aspects. Am J Ther, 1998, 5: 37-43.
27. 朱琳, 趙榮瑞, 張瑋芳, 等. 多巴胺受體激動劑對兔動脈cAMP產生系統(tǒng)的影響. 生理學報, 2000 , 52 : 247-251.
28. Riui A, Collier WI, Amentu F, et al. Endothelial Dopamine DA1 recep torsites in the rabbit pulmonary artery: autoradiographic demonstraction. Journal of harmacalogy & ecperimental Therapeutics, 2003, 261: 830-834.
29. 朱琳, 劉愛華, 趙榮瑞, 等. DA1 受體激動劑對大鼠離體肺動脈和腸動脈cAMP 生成量的影響. 河南醫(yī)科大學學報, 2001, 36 :249-251.
30. 支建明, 郭薇, 張煒芳, 等. 肺動脈高壓大鼠外周血管多巴胺-1型受體反應性的變化. 中國病理生理雜志, 1998, 14: 692-695 .
31. 曹惠芳, 徐鳳珍, 劉超, 等. 血漿內皮衍生性舒縮因子對急性肺損傷患者肺循環(huán)動力學及呼吸力學的影響. 中國呼吸與危重監(jiān)護雜志, 2003, 2: 87-90.
32. PENG HL, JIANG MH, YANG ZC, et al. Determination of betaadrenoceptor subtypes in human pulmonary artery andthoracic aorta by radiolig and binding. Acta Pharmacotoglca Sinica, 1993, 14: 298 -301.
33. 王節(jié)發(fā), 薛全福, 劉敬忠, 等. PCR 技術研究缺氧時大鼠肺腎上腺素能β2 受體及其mRNA 的變化. 中國病理生理雜志, 1995 ,11: 6-10.
  1. 1. Varpula M, Tallgren M, Saukkonen K, et al. Hemodynamic variables related to outcome in septic shock. Intensive Care Med, 2005, 31 :1066-1071.
  2. 2. Stevens T, Morris K, McMurtry IF, et al. Pulmonary and systemic vascular responsiveness to TNF-alpha in conscious rats. J Appl Physiol, 1993 , 74: 1905-1910.
  3. 3. Martin C, Viviand X, Leone M, et al. Effect of norepinephrine on the outcome of septic shock. Crit Care Med, 2000, 28: 2758-2765.
  4. 4. Dellinger RP, Levy MM, Carlet JM, et al. Surviving Sepsis Campaign: international guidelines for management of severe sepsis and septic shock: 2008 . Intensive Care Med, 2008, 34: 17-60.
  5. 5. 谷振勇, 凌亦凌, 孟愛宏, 等. 八肽膽囊收縮素對脂多糖誘導離體兔肺動脈反應性變化的影響. 中國病理生理雜志, 1999, 15 :484 -486.
  6. 6. Huang XL, Ling YL, Zhu TN, et al. The role of N-acetylcysteine against the injury of pulmonary artery induced by LPS. Chin J Appl Physiol, 2002 , 18: 370 -372.
  7. 7. 邢邯英, 凌亦凌, 孟愛宏, 等. 褪黑素改善內毒素血癥大鼠血管反應性. 生理學校, 2005, 57: 367-372.
  8. 8. Lee TS, Hou X. Vasoactive effects of ketamine on isolated rabbit pulmonary arteries. Chest, 1995 , 107: 1152-1155.
  9. 9. 徐叔云, 主編. 藥理實驗方法學, 第3 版. 北京: 人民衛(wèi)生出版社, 2002, 1535.
  10. 10. 朱綠綺. 感染性休克血管活性藥物的應用. 小兒急救醫(yī)學,2004, 11: 77-78 .
  11. 11. 索良源, 張錦. 去甲腎上腺素治療感染性休克時對肺靜脈血管阻力的影響. 中國呼吸與危重監(jiān)護雜志, 2009 , 8: 303-306 .
  12. 12. 趙悅, 王雪蓮, 劉沛, 等. 內毒素休克大鼠胸主動脈平滑肌細胞超微結構改變. 中國醫(yī)科大學校報, 2006, 35: 3-4.
  13. 13. 劉良明, 胡德耀, 陳惠孫, 等. 循環(huán)休克腎上腺素能受體失敏研究進展. 中國病理生理雜志, 1998, 14 : 100-103.
  14. 14. Kirkeb en KA, Strand OA. The role of nitric oxide in sepsis--an overview. Acta Anaesthesiol Scand, 1999, 43 : 275-288.
  15. 15. Sheridan BC, McIntyre RC Jr, Moore EE, et al. Neutrophils mediate pulmonary vasomotor dysfunction in endotoxin-induced acute lung injury. J Trauma, 1997, 42 : 391-396 .
  16. 16. Frostermann U, Pollock JS, Nakane M, et al. Noitric oxide synthases in the cardiovascular system. Trends Cardiovasc Med, 1993, 3 : 104 -110 .
  17. 17. 段國辰, 凌亦凌, 谷振勇, 等. 八肽膽囊收縮素對家兔內毒素休克時主動脈及肺動脈反應性改變的影響. 中國急救醫(yī)學, 2002 ,22: 693-697.
  18. 18. Atkinson J, Trescases N, Benedek C, et al. Alpha-1 and alpha-2 adrenoceptor agonists induce vasoconstriction of the normotensive ratcaudal artery in vitro by stimulation of a heterogeneous population of alpha-1 adrenoceptors. Naunyn Schmiedebergs Arch Pharmacol,1988, 338 : 529-535.
  19. 19. Luke J. Janssen, Hwa Lu-chao, et al. Netherton. Excitationcontraction coupling in pulmonary vascular smooth muscle involves tyrosine kinase and Rho kinase. Am J Physiol Lung Cell Mol Physiol, 2001 , 280: 666-674.
  20. 20. 陳瑋, 明佳, 徐競, 等. 內毒素休克后家兔血管反應性的變化規(guī)律及器官差異. 創(chuàng)傷外科雜志, 2008, 10: 456-459 .
  21. 21. Hasan A, McDonough KH. The effects of Escherichia coli sepsis and short-term ischemia on coronary vascular reactivity and myocardial function. Shock, 1997, 8: 305 -310.
  22. 22. Emmanuele DI, Villa Bianca R, Lippolis L, et al. Dexamethasone improves vascular hyporeactivity induced by lps in vivo by modulating ATP-sensitive potassium channels activity. Br J Pharmacol, 2003 , 140: 91-96 .
  23. 23. Boffa JJ, Arendshorst WJ. Maintenance of renal vascular reactivity contributes to acute renal failure during endotoxemic shock. J Am Soc Nephrol, 2005, 16: 117-124.
  24. 24. Takakura K, Xiaohong W, Takeuchi K, et al. Deactivation of norepinephrine by peroxynitrite as a new pathogenesis in the hypotension of septic shock. Anesthesiology, 2003 , 98: 928-934.
  25. 25. Polak MJ, Drummond WH. Systemic and pulmonary vascular effects of selective dopamine receptor blockade and stimulation in lambs.Pediatr Res, 1993 , 33: 181 -184.
  26. 26. Velasco M, Luchsinger A. Dopamine: pharmacologic and therapeutic aspects. Am J Ther, 1998, 5: 37-43.
  27. 27. 朱琳, 趙榮瑞, 張瑋芳, 等. 多巴胺受體激動劑對兔動脈cAMP產生系統(tǒng)的影響. 生理學報, 2000 , 52 : 247-251.
  28. 28. Riui A, Collier WI, Amentu F, et al. Endothelial Dopamine DA1 recep torsites in the rabbit pulmonary artery: autoradiographic demonstraction. Journal of harmacalogy & ecperimental Therapeutics, 2003, 261: 830-834.
  29. 29. 朱琳, 劉愛華, 趙榮瑞, 等. DA1 受體激動劑對大鼠離體肺動脈和腸動脈cAMP 生成量的影響. 河南醫(yī)科大學學報, 2001, 36 :249-251.
  30. 30. 支建明, 郭薇, 張煒芳, 等. 肺動脈高壓大鼠外周血管多巴胺-1型受體反應性的變化. 中國病理生理雜志, 1998, 14: 692-695 .
  31. 31. 曹惠芳, 徐鳳珍, 劉超, 等. 血漿內皮衍生性舒縮因子對急性肺損傷患者肺循環(huán)動力學及呼吸力學的影響. 中國呼吸與危重監(jiān)護雜志, 2003, 2: 87-90.
  32. 32. PENG HL, JIANG MH, YANG ZC, et al. Determination of betaadrenoceptor subtypes in human pulmonary artery andthoracic aorta by radiolig and binding. Acta Pharmacotoglca Sinica, 1993, 14: 298 -301.
  33. 33. 王節(jié)發(fā), 薛全福, 劉敬忠, 等. PCR 技術研究缺氧時大鼠肺腎上腺素能β2 受體及其mRNA 的變化. 中國病理生理雜志, 1995 ,11: 6-10.