Ujhelyi M R, Miller A W, Raibon S, Corley J, Robinson V J, Sims J J, Tonnessen T, Burke G, Ilebekk A, Rutlen D L
University of Georgia College of Pharmacy, Medical College of Georgia Department of Medicine, Augusta, USA.
Shock. 2000 Jul;14(1):68-72. doi: 10.1097/00024382-200014010-00012.
The splanchnic circulation constitutes a major portion of the total capacitance vasculature and may affect venous return and subsequently cardiac output during low output states. This study assessed the effects of rapid (10 microg/kg over 5 min) and slow (10 microg/kg over 60 min) induction of endotoxin (Escherichia coli) shock on splanchnic blood volume in 8 farm swine. Blood volume was measured by using Tc99m-labeled erythrocytes and radionuclide imaging. Baseline arterial pressure (MAP), central venous pressure (CVP), and liver, splenic, mesenteric and total splanchnic volumes were stable during the 30-min baseline. Approximately 30 min after the rapid endotoxin infusion, splenic volume decreased by 45%, whereas liver volume increased by 40% and MAP decreased by 60% (P < 0.01). The reduction in splenic volume occurred within 10 min of the endotoxin infusion, whereas liver volume changes occurred after MAP reduction. The slow endotoxin infusion also reduced splenic volume by approximately 50% (P = 0.05), whereas MAP declined by 30% (P < 0.05). However, the slow endotoxin infusion lowered liver volume (P < 0.05). Mesenteric volume was unaffected by the fast or slow endotoxin infusion. Total splanchnic volume was unaffected by the fast infusion but decreased by 37% in the slow infusion group (P < 0.05). In summary, E. coli endotoxin reduces splenic blood volume and increases liver blood volume after acute hypotension ensues. Endotoxin does not increase total splanchnic blood volume and may actually decrease total splanchnic volume in the absence of circulatory collapse. This endotoxin shock model is not associated with blood volume pooling in the splanchnic capacitance circulation.
内脏循环构成了整个容量血管系统的主要部分,在低输出状态下可能影响静脉回流,进而影响心输出量。本研究评估了快速(5分钟内10微克/千克)和缓慢(60分钟内10微克/千克)诱导内毒素(大肠杆菌)休克对8头农场猪内脏血容量的影响。通过使用锝99m标记的红细胞和放射性核素成像来测量血容量。在30分钟的基线期内,基线动脉压(MAP)、中心静脉压(CVP)以及肝脏、脾脏、肠系膜和总内脏体积均保持稳定。快速输注内毒素后约30分钟,脾脏体积减少了45%,而肝脏体积增加了40%,MAP下降了60%(P<0.01)。脾脏体积的减少在内毒素输注后10分钟内发生,而肝脏体积的变化在MAP下降之后出现。缓慢输注内毒素也使脾脏体积减少了约50%(P = 0.05),而MAP下降了30%(P<0.05)。然而,缓慢输注内毒素使肝脏体积降低(P<0.05)。肠系膜体积不受快速或缓慢输注内毒素的影响。总内脏体积不受快速输注的影响,但在缓慢输注组中减少了37%(P<0.05)。总之,大肠杆菌内毒素在急性低血压发生后会减少脾脏血容量并增加肝脏血容量。在内毒素休克模型中,内毒素不会增加总内脏血容量,在无循环衰竭的情况下实际上可能会减少总内脏体积。这种内毒素休克模型与内脏容量循环中的血容量积聚无关。