猪内毒素性低血压复苏模型的去甲肾上腺素输注和中心静脉波形:一项大型动物研究。

IF 2.1 4区 医学 Q2 SURGERY Journal of Investigative Surgery Pub Date : 2025-12-01 Epub Date: 2025-01-06 DOI:10.1080/08941939.2024.2445603
Zachary R Bergman, Roy K Kiberenge, Richard W Bianco, Gregory J Beilman, Colleen M Brophy, Kyle M Hocking, Bret D Alvis, Eric S Wise
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引用次数: 0

摘要

背景:静脉波形分析是利用快速傅立叶变换反卷积来估计血管内液体状态的一种新兴技术。流体状态已显示成正比的f0,波形的心脏波的基本频率的幅度在反褶积。利用猪分布性休克和液体复苏模型,我们试图确定去甲肾上腺素对中心静脉波形的影响。方法:8只猪在内毒素性低血压沉淀后麻醉、置管并给予去甲肾上腺素治疗,随后进行液体复苏,模拟脓毒症生理。血流动力学参数和中心静脉波形在整个方案中不断转导,用于事后分析。应用傅立叶分析法测定去甲肾上腺素给药前、中、后中心静脉波形。结果:在整个去甲肾上腺素给药过程中,心率升高,中心静脉压、肺毛细血管wedge压和脑卒中容积降低(p < 0),去甲肾上腺素预给药和剂量0.05、0.10、0.15、0.20和0.25 mcg/kg/min分别为2.5、1.4、1.7、1.7、1.6和1.4 mmHg2(重复测量方差分析;0.05 mcg/kg/min时pf0降低(P = 0.04)。结论:由于f0在液体给药期间的表现,这些数据为f0在血管加压药输送期间的表现提供了新的见解。中心静脉波形f0在去甲肾上腺素作用下呈下降,与肺毛细血管楔压一致。这允许在血管加压剂给药过程中对新的静脉来源信号0进行语境化处理,这一发现必须在临床翻译之前被理解。
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Norepinephrine Infusion and the Central Venous Waveform in a Porcine Model of Endotoxemic Hypotension with Resuscitation: A Large Animal Study.

Background: Venous waveform analysis is an emerging technique to estimate intravascular fluid status by fast Fourier transform deconvolution. Fluid status has been shown proportional to f0, the amplitude of the fundamental frequency of the waveform's cardiac wave upon deconvolution. Using a porcine model of distributive shock and fluid resuscitation, we sought to determine the influence of norepinephrine on f0 of the central venous waveform.

Methods: Eight pigs were anesthetized, catheterized and treated with norepinephrine after precipitation of endotoxemic hypotension, and subsequent fluid resuscitation to mimic sepsis physiology. Hemodynamic parameters and central venous waveforms were continually transduced throughout the protocol for post-hoc analysis. Central venous waveform f0 before, during and after norepinephrine administration were determined using Fourier analysis.

Results: Heart rate increased, while central venous pressure, pulmonary capillary wedge pressure and stroke volume decreased throughout norepinephrine administration (p < 0.05). Mean f0 at pre-norepinephrine, and doses 0.05, 0.10, 0.15, 0.20 and 0.25 mcg/kg/min, were 2.5, 1.4, 1.7, 1.7, 1.6 and 1.4 mmHg2, respectively (repeated measures ANOVA; p < 0.001). On post-hoc comparison to pre-norepinephrine, f0 at 0.05 mcg/kg/min was decreased (p = 0.04).

Conclusions: As the performance of f0 was previously characterized during fluid administration, these data offer novel insight into the performance of f0 during vasopressor delivery. Central venous waveform f0 is a decreased with norepinephrine, in concordance with pulmonary capillary wedge pressure. This allows contextualization of the novel, venous-derived signal f0 during vasopressor administration, a finding that must be understood prior to clinical translation.

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来源期刊
CiteScore
4.20
自引率
0.00%
发文量
114
审稿时长
6-12 weeks
期刊介绍: Journal of Investigative Surgery publishes peer-reviewed scientific articles for the advancement of surgery, to the ultimate benefit of patient care and rehabilitation. It is the only journal that encompasses the individual and collaborative efforts of scientists in human and veterinary medicine, dentistry, basic and applied sciences, engineering, and law and ethics. The journal is dedicated to the publication of outstanding articles of interest to the surgical research community.
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