血管升压类药物通过从体循环向肺循环血液流量的重新分布导致被动性肺动脉高压

Vasopressors induce passive pulmonary hypertension by blood redistribution from systemic to pulmonary circulation
2017-04-19 11:39发表评论
作者:Chunling JiangHong QianShuhua LuoJing LinJerry YuYajiao LiQi AnNanfu LuoLei DuEmail
机构: 四川大学华西医院
期刊: BASIC RES CARDIOL 2017年5月21期112卷

Vasopressors are widely used in resuscitation, ventricular failure, and sepsis, and often induce pulmonary hypertension with undefined mechanisms. We hypothesize that vasopressor-induced pulmonary hypertension is caused by increased pulmonary blood volume and tested this hypothesis in dogs under general anesthesia. In normal hearts (model 1), phenylephrine (2.5 μg/kg/min) transiently increased right but decreased left cardiac output, associated with increased pulmonary blood volume (63% ± 11.8, P = 0.007) and pressures in the left atrium, pulmonary capillary, and pulmonary artery. However, the trans-pulmonary gradient and pulmonary vascular resistance remained stable. These changes were absent after decreasing blood volume or during right cardiac dysfunction to reduce pulmonary blood volume (model 2). During double-ventricle bypass (model 3), phenylephrine (1, 2.5 and 10 μg/kg/min) only slightly induced pulmonary vasoconstriction. Vasopressin (1U and 2U) dose-dependently increased pulmonary artery pressure (52 ± 8.4 and 71 ± 10.3%), but did not cause pulmonary vasoconstriction in normally beating hearts (model 1). Pulmonary artery and left atrial pressures increased during left ventricle dysfunction (model 4), and further increased after phenylephrine injection by 31 ± 5.6 and 43 ± 7.5%, respectively. In conclusion, vasopressors increased blood volume in the lung with minimal pulmonary vasoconstriction. Thus, this pulmonary hypertension is similar to the hemodynamic pattern observed in left heart diseases and is passive, due to redistribution of blood from systemic to pulmonary circulation. Understanding the underlying mechanisms may improve clinical management of patients who are taking vasopressors, especially those with coexisting heart disease.

通讯机构:Department of Anesthesiology and Translational Neuroscience Center, West China HospitalSichuan UniversityChengduChina
学科代码:心血管病学   关键词:血管升压类药物 体循环 肺循环血液流量 ,中国作者重要发表 爱思唯尔医学网, Elseviermed
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