Objectives: To determine the effects of continuous morphine infusion in ventil ated newborns on plasma concentrations of adrenaline (epinephrine) and noradrena line (norepinephrine)-and their relation to clinical outc...Objectives: To determine the effects of continuous morphine infusion in ventil ated newborns on plasma concentrations of adrenaline (epinephrine) and noradrena line (norepinephrine)-and their relation to clinical outcome. Design: Blinded, randomised, placebo controlled trial. Setting: Level III neonatal intensive care units in two centres. Patients: A total of 126 ventilated neonates (inclusion c riteria: postnatal age < 3 days, duration of ventilation < 8 hours, indwelling a rterial catheter for clinical purposes; exclusion criteria: severe asphyxia, sev ere intraventricular haemorrhage, major congenital anomalies, neuromuscular bloc kers). Interventions: Plasma adrenaline and noradrenaline concentrations were de termined in patients during blinded morphine (n = 60) and placebo (n = 66) infus ion (100 μg/kg plus 10 μg/kg/h). Results: Plasma concentrations at baseline (n mol/l with interquartile range in parentheses) were comparable in infants treate d with morphine (adrenaline, 0.22 (0.31); noradrenaline, 2.52 (2.99)) or pla cebo (adrenaline, 0.29 (0.46); noradrenaline, 2.44 (3.14)). During infusion, median adrenaline concentrations were 0.12 (0.28) and 0.18 (0.35)-and medi an noradrenaline concentrations were 2.8 (3.7) and 3.8 (4.0) for the morphin e and placebo treated infants respectively. Multivariate analyses showed that no radrenaline (p = 0.029), but not adrenaline (p = 0.18), concentrations were si gnificantly lower in the morphine group than the placebo group. Furthermore, nor adrenaline concentrations were related to the length of stay in the neonatal int ensive care unit. Conclusions: Continuous morphine infusion significantly decrea sed plasma noradrenaline concentrations in ventilated newborns compared with pla cebo treatment. The results of this study support the idea that routine morphine administration decreases stress responses in ventilated neonates.展开更多
目的通过超容量负荷联合压力负荷构建非缺血性家兔心力衰竭(心衰)模型,观察辛伐他汀对心衰家兔左室收缩功能和交感活性的影响,以阐明辛伐他汀改善非缺血性心衰心功能的可能机制。方法 (1)实验分组:30只家兔随机分为3组:假手术组(n=10)...目的通过超容量负荷联合压力负荷构建非缺血性家兔心力衰竭(心衰)模型,观察辛伐他汀对心衰家兔左室收缩功能和交感活性的影响,以阐明辛伐他汀改善非缺血性心衰心功能的可能机制。方法 (1)实验分组:30只家兔随机分为3组:假手术组(n=10)、心衰组(n=10)、心衰辛伐他汀干预组(n=10);(2)心衰模型的建立:心衰组和辛伐他汀干预组家兔均联合应用主动脉瓣破瓣术及腹主动脉缩窄术建立非缺血性心衰模型,共观察7周;(3)心功能的测定:利用左心导管术和心脏多谱勒观察家兔血流动力学和心脏功能的变化,并应用酶联免疫法(ELISA)测定血浆脑钠肽水平;(4)家兔交感活性的测定:应用ELISA法检测血浆肾上腺素(EPI)、去甲肾上腺素(NE)水平,以及蛋白免疫印迹法(Western blot)检测心肌组织蛋白激酶A(PKA)、受磷蛋白(PLB)及受磷蛋白第16位丝氨酸磷酸化(Ser16-P-PLB)的蛋白表达水平,并采用UVIDoc成像仪进行蛋白表达半定量分析。结果 (1)三组家兔心功能的比较:与假手术组相比,心衰组家兔左室舒张末压(LVEDP)(mm Hg:-7±4.61 vs 24.6±6.73)、脑钠肽(BNP)(pmol/mL:4.41±0.94 vs 24.40±4.78)明显增加(PP vs8.48±1.08)水平明显降低(PEF值(%:47.8±6.05 vs63.51±4.34)均明显增加(P<0.05)。(2)三组家兔交感活性的比较:与假手术组比较,心衰组家兔心率(HR)(次/min:223±21.91 vs 268±16.73)、血浆肾上腺素(EPI)(pg/ml:8.16±1.45 vs 25.40±4.78)、去甲肾上腺素(NE)(pg/ml:86.14±12.24 vs 173.04±39.15)水平明显升高、心肌组织蛋白激酶A(PKA)(RPKA/actin:0.38±0.12 vs 0.88±0.15)和PLB第16位丝氨酸磷酸化(Ser16-P-PLB)(Rser16-P-PLB/actin:0.44±0.14 vs 0.86±0.16)表达水平均增加(PPKA/actin:0.88±0.15 vs 10.43±0.11)和Ser16-P-PLB(Rser16-P-PLB/actin:0.86±0.16 vs 0.47±0.14)表达水平均明显降低(P<0.05);差别有统计学意义。结论 (1)在超容量负荷和超压力负荷持续作用下,家兔左室收缩功能减退,并且伴有体内交感活性增强;(2)辛伐他汀能够抑制交感神经系统过度激活,延缓超容量负荷和超压力负荷持续作用导致的家兔左室收缩功能减退及心室重构;(3)辛伐他汀抗交感能力主要反映在:抑制循环中儿茶酚胺水平及儿茶酚胺-蛋白激酶A-磷酸化受磷蛋白途径。(4)辛伐他汀延缓非缺血性心衰进展可能与其抑制交感神经系统过度激活相关。展开更多
文摘Objectives: To determine the effects of continuous morphine infusion in ventil ated newborns on plasma concentrations of adrenaline (epinephrine) and noradrena line (norepinephrine)-and their relation to clinical outcome. Design: Blinded, randomised, placebo controlled trial. Setting: Level III neonatal intensive care units in two centres. Patients: A total of 126 ventilated neonates (inclusion c riteria: postnatal age < 3 days, duration of ventilation < 8 hours, indwelling a rterial catheter for clinical purposes; exclusion criteria: severe asphyxia, sev ere intraventricular haemorrhage, major congenital anomalies, neuromuscular bloc kers). Interventions: Plasma adrenaline and noradrenaline concentrations were de termined in patients during blinded morphine (n = 60) and placebo (n = 66) infus ion (100 μg/kg plus 10 μg/kg/h). Results: Plasma concentrations at baseline (n mol/l with interquartile range in parentheses) were comparable in infants treate d with morphine (adrenaline, 0.22 (0.31); noradrenaline, 2.52 (2.99)) or pla cebo (adrenaline, 0.29 (0.46); noradrenaline, 2.44 (3.14)). During infusion, median adrenaline concentrations were 0.12 (0.28) and 0.18 (0.35)-and medi an noradrenaline concentrations were 2.8 (3.7) and 3.8 (4.0) for the morphin e and placebo treated infants respectively. Multivariate analyses showed that no radrenaline (p = 0.029), but not adrenaline (p = 0.18), concentrations were si gnificantly lower in the morphine group than the placebo group. Furthermore, nor adrenaline concentrations were related to the length of stay in the neonatal int ensive care unit. Conclusions: Continuous morphine infusion significantly decrea sed plasma noradrenaline concentrations in ventilated newborns compared with pla cebo treatment. The results of this study support the idea that routine morphine administration decreases stress responses in ventilated neonates.
文摘目的通过超容量负荷联合压力负荷构建非缺血性家兔心力衰竭(心衰)模型,观察辛伐他汀对心衰家兔左室收缩功能和交感活性的影响,以阐明辛伐他汀改善非缺血性心衰心功能的可能机制。方法 (1)实验分组:30只家兔随机分为3组:假手术组(n=10)、心衰组(n=10)、心衰辛伐他汀干预组(n=10);(2)心衰模型的建立:心衰组和辛伐他汀干预组家兔均联合应用主动脉瓣破瓣术及腹主动脉缩窄术建立非缺血性心衰模型,共观察7周;(3)心功能的测定:利用左心导管术和心脏多谱勒观察家兔血流动力学和心脏功能的变化,并应用酶联免疫法(ELISA)测定血浆脑钠肽水平;(4)家兔交感活性的测定:应用ELISA法检测血浆肾上腺素(EPI)、去甲肾上腺素(NE)水平,以及蛋白免疫印迹法(Western blot)检测心肌组织蛋白激酶A(PKA)、受磷蛋白(PLB)及受磷蛋白第16位丝氨酸磷酸化(Ser16-P-PLB)的蛋白表达水平,并采用UVIDoc成像仪进行蛋白表达半定量分析。结果 (1)三组家兔心功能的比较:与假手术组相比,心衰组家兔左室舒张末压(LVEDP)(mm Hg:-7±4.61 vs 24.6±6.73)、脑钠肽(BNP)(pmol/mL:4.41±0.94 vs 24.40±4.78)明显增加(PP vs8.48±1.08)水平明显降低(PEF值(%:47.8±6.05 vs63.51±4.34)均明显增加(P<0.05)。(2)三组家兔交感活性的比较:与假手术组比较,心衰组家兔心率(HR)(次/min:223±21.91 vs 268±16.73)、血浆肾上腺素(EPI)(pg/ml:8.16±1.45 vs 25.40±4.78)、去甲肾上腺素(NE)(pg/ml:86.14±12.24 vs 173.04±39.15)水平明显升高、心肌组织蛋白激酶A(PKA)(RPKA/actin:0.38±0.12 vs 0.88±0.15)和PLB第16位丝氨酸磷酸化(Ser16-P-PLB)(Rser16-P-PLB/actin:0.44±0.14 vs 0.86±0.16)表达水平均增加(PPKA/actin:0.88±0.15 vs 10.43±0.11)和Ser16-P-PLB(Rser16-P-PLB/actin:0.86±0.16 vs 0.47±0.14)表达水平均明显降低(P<0.05);差别有统计学意义。结论 (1)在超容量负荷和超压力负荷持续作用下,家兔左室收缩功能减退,并且伴有体内交感活性增强;(2)辛伐他汀能够抑制交感神经系统过度激活,延缓超容量负荷和超压力负荷持续作用导致的家兔左室收缩功能减退及心室重构;(3)辛伐他汀抗交感能力主要反映在:抑制循环中儿茶酚胺水平及儿茶酚胺-蛋白激酶A-磷酸化受磷蛋白途径。(4)辛伐他汀延缓非缺血性心衰进展可能与其抑制交感神经系统过度激活相关。
