실험연구 : 출혈성 쇼크에서 Phenylephrine이 심장작업수행능력과 심근산소균형에 미치는 영향 = The Effect of Phenylephrine on Cardiac Performance and Myocardial Oxygen Balance in Resuscitation from Hemorrhagic Shock

다국어 초록 (Multilingual Abstract)

Background: The issue of using phenylephrine in hemorrhagic shock treatment has been controversial because it is known that phenylephrine improves the tissue perfusion by increasing arterial blood pressure but deteriorates the myocardium by increasing afterload and decreasing myocardial oxygen delivery via coronary vasoconstriction. This study was aimed to assess the effects of phenylephrine on hemodynamic variables, cardiac performance, and myocardial oxygen balance in resuscitation from hemorrhagic shock. Methods: Twenty anesthetized dogs were randomly divided into phenylephrine group and control group. After inducing hemorrhagic shock, resuscitation was done with phenylephrine and 0.9% normal saline respectively. We measured hemodynamic indices, blood gas parameter and cardiac enzymes which indicate myocardial demage. Results: In both groups, cardiac output and hemodynamic indices improved. In phenylephrine group, the systemic oxygen delivery and consumption was much higher and the myocardial oxygen extraction ratio was maintained at the lower level than the control group. In addition, the CK-MB was higher at the early phase of resuscitation and the troponin T was also higher than the control group during the whole period of resuscitation. Creatine kinase-MB increased during early resuscitation in phenylephrine group but kept decreasing after that and there`s no difference between two groups. Troponin T was higher in the phenylephrine group after resuscitation. Conclusions: We concluded that phenylephrine improves myocardial oxygen balance and contractility without serious myocardial demage during resuscitation from hemorrhagic shock. (Korean J Anesthesiol 2007; 52: 571~7)