氨茶碱联合纳洛酮治疗早产儿原发性呼吸暂停疗效观察

目的 观察氨茶碱联合纳洛酮治疗早产儿原发性呼吸暂停的疗效.方法 60例原发性呼吸暂停早产儿随机分为两组,在常规治疗基础上,两组均应用氨茶碱,首剂5 mg/kg,12 h后给予维持量2.5 mg/kg,每12 h给药1次;治疗组加用纳洛酮10 μg/(kg·h),每8h或12 h给药1次.结果 治疗组总有效率为93.3％,对照组总有效率为70.0％.两组总有效率比较差异有统计学意义(x2=4.01,P＜0.05).结论 氨茶碱与纳洛酮联合应用优于单纯用氨茶碱治疗早产儿原发性呼吸暂停.     

Effects of naloxone on exercise performance

This study was designed to investigate the effects of naloxone on athletic performance in humans. Two groups of elite middle-distance runners performed a maximal or a submaximal exercise protocol following the double-blind intravenous injection of either naloxone (0.15 mg X kg body wt-1) or saline. The maximal test (group M) was comprised of a short-duration treadmill run to maximal intensity; the submaximal test (group S), a prolonged submaximal treadmill run to exhaustion. O2 uptake, heart rate, ventilation, and perceived exertion were determined during each test. Perception of pain was assessed after exercise by use of a modified McGill pain questionnaire. No significant differences between placebo and naloxone treatments were found in any of the measured variables at the usually accepted 5% (P = 0.05) confidence level; however, evidence suggesting differences (i.e., P = 0.1 to 0.05) in these important respects was observed. In group M, maximal exercise performance measured by maximal O2 consumption was not different between placebo and naloxone; results suggest that VE was increased (P = 0.08) following naloxone, but only at the final work stage. In group S, exercise performance time was reduced following naloxone (P = 0.09), whereas the affective component of pain was increased (P = 0.06); no differences in the measured physiological variables were observed. These results suggest the following: 1) the opiate receptor-endorphin system may alter the perception of pain associated with prolonged high-intensity submaximal exercise with a resultant significant effect on performance; and 2) it may play a role in the control of ventilation during maximal exercise.     

Effects of naloxone on plasma corticosterone in the opiate-naive rat

Naloxone HCl (NX) has long been considered to be a pure narcotic antagonist, having an effect only subsequent to pretreatment with a narcotic. Characteristically, low doses of NX have been used to antagonize the effects of analgesic doses of narcotics and to precipitate withdrawal in chronically treated animals. In this study, the effects of high doses of NX (2.0–20.0 mg/kg) on changes in plasma corticosterone were examined in the opiate-naive animal. Using male rats with chronic intravenous catheters and one-way vision boxes, injections were made and serial blood samples were obtained in the conscious, unrestrained animal. The acute administration of NX to the opiate-naive animal produced a dose-related increase in plasma corticosterone with respect to both amplitude and duration. NX (10.0 mg/kg i.v.) produced a significant elevation in hormone level at 15 and 30 minutes. With NX (20.0 mg/kg i.v.) the duration of the response was extended to 60 minutes. To examine whether short-term tolerance to this effect could be produced, animals were given a single pretreatment with either NX (10.0 mg/kg) or saline i.v. Two hours later NX produced a similar elevation in hormone level in both groups. The effect of chronic injection of NX was also studied. Animals pretreated with either NX (10.0 mg/kg) or saline s.c. once daily for 7 days did not show a significant difference following the subsequent administration of NX. In both cases, a significant elevation of plasma corticosterone resulted. The results suggest that NX may have a direct effect on opiate receptors resulting in an elevation of plasma hormone levels or NX may be disrupting an endogenous opiate-receptor interaction producing a stress response.     

Effects of naloxone on pethidine-induced neonatal depression. Part I--Intravenous naloxone.

Infants whose mothers had had pethidine during labour were given either naloxone 40 microgram or isotonic saline administered intravenously double-blind within one minute of birth. Peak alveolar carbon dioxide tension, carbon dioxide excretion, alveolar ventilation, feeding behaviour, and habituation to a specific sound stimulus were measured regularly up to 48 hours after birth. Alveolar carbon dioxide tension was significantly lower and alveolar ventilation significantly higher half an hour after birth in the naloxone-treated group than in the saline-treated group, but these differences between the groups were not significant at any other time, and there were no significant differences in sucking frequency or pressure, milk consumption, or habituation to the auditory stimulus.     

Effects of naloxone on pethidine-induced neonatal depression. Part II--Intramuscular naloxone.

Thirty full-term infants whose mothers had had pethidine during labour were given either naloxone 200 microgram or normal saline intramuscularly. The drugs were chosen blindly and administered within one minute of birth. Naloxone produced a significant reduction in mean alveolar carbon dioxide tension and an increase in carbon dioxide excretion and mean alveolar ventilation at all times up to 48 hours after birth. The mean rate of habituation to a repeated auditory stimulus, the mean sucking frequency, the sucking pressure, and the mean consumption of milk were all significantly higher in the naloxone-treated group than in the placebo-treated group up to 48 hours after birth. Intramuscular naxolone therefore seemed to reverse the undesirable effects of pethidine.     

Increased propensity for apnea via dopamine-induced carotid body inhibition in sleeping dogs.

We determined the effects of specific carotid body chemoreceptor inhibition on the propensity for apnea during sleep. We reduced the responsiveness of the carotid body chemoreceptors using intravenous dopamine infusions during non-rapid eye movement sleep in six dogs. Then we quantified the difference in end-tidal Pco(2) (Pet(CO(2))) between eupnea and the apneic threshold, the "CO(2) reserve," by gradually reducing Pet(CO(2)) transiently with pressure support ventilation at progressively increased tidal volume until apnea occurred. Dopamine infusions decreased steady-state eupneic ventilation by 15 +/- 6%, causing a mean CO(2) retention of 3.9 +/- 1.9 mmHg and a brief period of ventilatory instability. The apneic threshold Pet(CO(2)) rose 5.1 +/- 1.9 Torr; thus the CO(2) reserve was narrowed from -3.9 +/- 0.62 Torr in control to -2.7 +/- 0.78 Torr with dopamine. This decrease in the CO(2) reserve with dopamine resulted solely from the 20.5 +/- 11.3% increase in plant gain; the slope of the ventilatory response to CO(2) below eupnea was unchanged from normal. We conclude that specific carotid chemoreceptor inhibition with dopamine increases the propensity for apnea during sleep by narrowing the CO(2) reserve below eupnea. This narrowing is due solely to an increase in plant gain as the slope of the ventilatory response to CO(2) below eupnea was unchanged from normal control. These findings have implications for the role of chemoreceptor inhibition/stimulation in the genesis of apnea and breathing periodicity during sleep.     

Effects of immobilization of a limb on the maturation of a peripheral nerve in kittens

Right or left hindlimbs of kittens were immobilized in a plaster cast, in the resting position. Three groups of animals belonged to the same age group, one to older, and another to younger. Kittens in the same age group were subjected to progressively increasing periods of immobilization, the older group to a shorter and the younger to the longest period. By virtue of this arrangement, it was found that the demonstrated changes in the peripheral nerve, which included a decrease in the myelinated nerve fibre population and a reduction in the mean nerve fibre diameter, have been proportionate among the animals in the same age group, more pronounced in younger, and less so in older ones, indicating that in younger animals longer periods of immobilization lead to a greater degree of harmful effects, although it was also evident that younger animals attempt to adapt to such adverse conditions.     

Effects of naloxone on breathing movements during hypercapnia in the fetal lamb

To determine whether endogenous opioids influence the fetal breathing response to CO2 we have investigated the effect of the opiate antagonist, naloxone on the incidence, rate, and amplitude of breathing movements during hypercapnia in fetal lambs in utero. In 20 experiments in six pregnant sheep (130-145 days gestation) hypercapnia was induced by giving the ewe 4-6% CO2-18% O2 in N2 to breathe for 60 min. After 30 min of hypercapnia either naloxone (13 experiments) or saline (7 experiments) was infused intravenously for the remaining 30 min. During hypercapnia breath amplitude increased from 5.8 +/- 0.5 to 9.1 +/- 1.2 mmHg (P less than 0.001), and infusion of naloxone was associated with a further significant increase to 15.7 +/- 1.2 mmHg (P less than 0.001). Naloxone had no effect on the incidence or rate of breathing movements during hypercapnia. After hypercapnia there was a significant decrease in the incidence of fetal breathing movements in the naloxone group (14.7 +/- 3.2%). Infusion of saline during hypercapnia had no effect on incidence, rate, or amplitude of fetal breathing movements. These results suggest that endogenous opioids act to suppress or limit breath amplitude during hypercapnia but do not affect rate or incidence of breathing movements.     

Effects of tetanic stimulation on monosynaptic and dorsal root reflexes in kittens.

The effects of tetanic stimulation of peripheral afferents were examined on monosynaptic reflexes and dorsal root reflexes in kittens of various ages. Concomitantly recorded monosynaptic and dorsal root reflexes resulting from the stimulation of muscle nerves showed similar post-tetanic changes, namely, predominantly post-tetanic depression in neonates and post-tetanic potentiation in older kittens or adults. However, the changes in post-tetanic responses expressed as a percentage of control in dorsal root reflexes were much smaller than those in monosynaptic reflexes. When dorsal root reflexes originating from muscle and cutaneous afferents were compared, dorsal root reflexes from the latter behaved quite differently. For all ages, post-tetanic effects on dorsal root reflexes arising from cutaneous afferents were either insignificant or very small. The possible mechanisms underlying differences in post-tetanic effects from muscle and cutaneous afferents in adults and neonates are discussed.     

Effects of caffeine on carotid sinus nerve chemosensory discharge in kittens and cats

Bairam, A., P. De Grandpré, C. Dauphin, and F. Marchal. Effects of caffeine on carotid sinus nervechemosensory discharge in kittens and cats. J. Appl.Physiol. 82(2): 413-418, 1997.Caffeine (C)decreases apneic episodes in premature infants and is thought tostimulate breathing mainly by a central mechanism. While the methylxanthines theophylline and aminophylline are known to alter thecarotid chemoreceptor activity, there are little data on C. The aim ofthe study was to examine the effects of C on the carotid sinus nervedischarge (CSND) in developing animals. Nine kittens 17-21 daysold and six adult cats that were anesthetized and artificially ventilated were studied. They received four consecutive doses of C,each of 10 mg/kg, administered at intervals of 20 min either asintravenous bolus injection (6 kittens, 3 cats) or continuous infusion(3 kittens, 3 cats). Bolus injections of C invariably induced a promptbut transient increase in the CSND from 4.1 ± 0.6 to 8.1 ± 1.0 (SE) impulses/s in kittens (P = 0.01)and from 3.9 ± 0.1 to 7.9 to 1.0 impulses/s in cats (after thefirst injection). This response was associated with a significantdecrease in arterial blood pressure. Continuous infusion of C did notinduce any early change in either CSND or blood pressure in kittens orcats. Fifteen minutes after C injection or infusion was begun, CSNDvalues in air, 8% O₂-balanceN₂, or 100%O₂ were not significantlydifferent from control. Haloperidol administered at theend of the experiment in four cats and four kittens significantlyincreased CSND and did not suppress the early response to C injection.It is concluded that caffeine administered by bolus in the kitteninduces a transient stimulation of the CSND that is associated with adecrease in the arterial blood pressure and is independent of thedopaminergic mechanisms in the carotid body. The lack of sustainedeffect implies the main mechanism to the ventilatory stimulation by Cmust be central.

     

Effects of naloxone on renal responses to noxious stimuli in the cynomolgus monkey

Behavioral influences on excretion of Na⁺ and H₂O were studied during saline diuresis in three unanesthetized adult female cynomolgus monkeys. During control infusions of isotonic saline, the average rates of urine and Na⁺ excretion were 210μl/kg/min and 36.1μl/kg/min, respectively, and the average rate of inulin clearance was 4.6 ml/kg/min. Intermittent exposure to an electrical stimulus applied to the monkey's tail for a 30-min period modestly reduced rates of excretion of Na⁺ and H₂O; these reductions were 58% and 56% of baseline values respectively during the first 10 min, but excretion rates returned to baseline values or exceeded them by the end of the 30-min period. The effects of naloxone hydrochloride (10 mg/kg), an opiate antagonist, were studied by administering the drug immediately before the period of electrical-stimulus delivery. After naloxone, the electrical-stimulus markedly reduced the rates of Na⁺ and H₂O excretion to 29% and 31% of baseline values during the first 10 min, and delayed the return to baseline values. Inulin clearance was not altered significantly by the electrical stimulus in the absence of naloxone, but was decreased to 32% of the baseline rate during the first 10 min of exposure to the electric stimulus in the presence of naloxone. Naloxone had similar effects on rates of Na⁺ and urine excretion in response to 30 min of 108 dBA noise. These results show that renal responses to noxious environmental stimuli (electrical stimulus or noise) can be altered by naloxone.