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首页> 外文期刊>Critical care : >Meperidine and skin surface warming additively reduce the shivering threshold: a volunteer study
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Meperidine and skin surface warming additively reduce the shivering threshold: a volunteer study

机译：一项志愿者研究表明，哌替啶和皮肤表面变暖可增加发抖阈值

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IntroductionMild therapeutic hypothermia has been shown to improve outcome for patients after cardiac arrest and may be beneficial for ischaemic stroke and myocardial ischaemia patients. However, in the awake patient, even a small decrease of core temperature provokes vigorous autonomic reactions–vasoconstriction and shivering–which both inhibit efficient core cooling. Meperidine and skin warming each linearly lower vasoconstriction and shivering thresholds. We tested whether a combination of skin warming and a medium dose of meperidine additively would reduce the shivering threshold to below 34°C without producing significant sedation or respiratory depression.MethodsEight healthy volunteers participated on four study days: (1) control, (2) skin warming (with forced air and warming mattress), (3) meperidine (target plasma level: 0.9 μg/ml), and (4) skin warming plus meperidine (target plasma level: 0.9 μg/ml). Volunteers were cooled with 4°C cold Ringer lactate infused over a central venous catheter (rate ≈ 2.4°C/hour core temperature drop). Shivering threshold was identified by an increase of oxygen consumption (+20% of baseline). Sedation was assessed with the Observer's Assessment of Alertness/Sedation scale.ResultsControl shivering threshold was 35.5°C ± 0.2°C. Skin warming reduced the shivering threshold to 34.9°C ± 0.5°C (p = 0.01). Meperidine reduced the shivering threshold to 34.2°C ± 0.3°C (p < 0.01). The combination of meperidine and skin warming reduced the shivering threshold to 33.8°C ± 0.2°C (p < 0.01). There were no synergistic or antagonistic effects of meperidine and skin warming (p = 0.59). Only very mild sedation occurred on meperidine days.ConclusionA combination of meperidine and skin surface warming reduced the shivering threshold to 33.8°C ± 0.2°C via an additive interaction and produced only very mild sedation and no respiratory toxicity.
机译：简介轻度低温治疗已显示可改善心脏骤停后患者的预后，可能对缺血性中风和心肌缺血患者有益。但是，在清醒的患者中，即使核心温度略有下降也会引起剧烈的自主反应-血管收缩和发抖-均会抑制核心的有效冷却。哌替啶和皮肤变热分别线性降低血管收缩和发抖的阈值。我们测试了皮肤增温和中等剂量的哌替啶的组合是否会在不产生明显的镇静作用或呼吸抑制的情况下将发抖阈值降低至34°C以下。方法八名健康志愿者参加了四个研究日：（1）对照，（2） （3）哌替啶（目标血浆水平：0.9μg/ ml），以及（4）皮肤保暖加哌替丁（目标血浆水平：0.9μg/ ml）。志愿者通过在中央静脉导管上注入4°C的冷乳酸林格氏菌进行冷却（速率≈2.4°C /小时核心温度下降）。颤抖阈值是通过耗氧量的增加（基线值的20％）来确定的。用观察者的警觉性/镇静评估量表评估镇静作用。结果控制颤抖阈值为35.5°C±0.2°C。皮肤变暖将发抖阈值降低到34.9°C±0.5°C（p = 0.01）。哌替啶将冷颤阈值降低至34.2°C±0.3°C（p <0.01）。哌替啶和皮肤加热的结合使发抖阈值降低至33.8°C±0.2°C（p <0.01）。哌替啶和皮肤增温没有协同或拮抗作用（p = 0.59）。结论哌替啶与皮表温度的结合通过加性相互作用将发抖阈值降低至33.8°C±0.2°C，并且仅产生非常轻度的镇静作用，而没有呼吸道毒性。

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