Kuwagata Y, Oda J, Matsuyama S, Nishino M, Hashiguchi N, Ogura H, Tanaka H, Sugimoto H
Department of Acute Critical Medicine, Osaka University Medical School, Suita, Japan.
Shock. 2000 Aug;14(2):193-9. doi: 10.1097/00024382-200014020-00020.
When systemic oxygen delivery (DO2) is reduced, oxygen consumption (VO2) is maintained until a critical level is reached (DO2crit). Sepsis is thought to shift DO2crit to the right and lengthen the supply-dependent portion. We tested the effect of interleukin (IL)-1beta, which is one of the key cytokines related to sepsis, on the DO2-VO2 relationship. Fifteen rabbits were subjected to stepwise cardiac tamponade to reduce DO2 to 10% by inflating a handmade balloon placed into the pericardial sac. Seven rabbits were given 10 microg/kg of IL-1beta intravenously (IL-1beta group) prior to the graded cardiac tamponade. The remainder received saline alone (control group). The DO2-VO2 relationship was analyzed by the dual-line method. IL-1beta significantly decreased mean arterial pressure (65 +/- 11 mmHg from baseline 85 +/- 7 mmHg) without altering cardiac output. The IL-1beta group showed significantly steeper supply-independent line slopes than did the control group (0.19 +/- 0.02 vs. 0.11 +/- 0.02, respectively), which resulted in a DO2crit shift to the left (IL-1beta group, 8.7 +/- 1.7 ml/kg x min vs. control, 11.7 +/- 0.7 ml/kg x min). The IL-1beta group also showed greater PO2 and plasma lactate levels in the portal vein than did the control group. These results indicate that IL-1beta impairs systemic oxygen uptake even before VO2 becomes supply-dependent, presumably due to maldistribution of the blood flow including the splanchnic circulation.
当全身氧输送(DO2)降低时,氧消耗(VO2)会维持不变,直至达到临界水平(DO2crit)。脓毒症被认为会使DO2crit右移,并延长氧供应依赖部分。我们测试了白细胞介素(IL)-1β(脓毒症相关的关键细胞因子之一)对DO2-VO2关系的影响。通过向心包腔内插入自制球囊并充气,使15只兔子逐步发生心脏压塞,将DO2降至10%。7只兔子在分级心脏压塞前静脉注射10μg/kg的IL-1β(IL-1β组)。其余兔子仅接受生理盐水(对照组)。采用双线法分析DO2-VO2关系。IL-1β显著降低平均动脉压(从基线的85±7mmHg降至65±11mmHg),而不改变心输出量。IL-1β组的非氧供应依赖线斜率显著陡于对照组(分别为0.19±0.02和0.11±0.02),这导致DO2crit左移(IL-1β组为8.7±1.7ml/kg·min,对照组为11.7±0.7ml/kg·min)。IL-1β组门静脉的PO2和血浆乳酸水平也高于对照组。这些结果表明,IL-1β即使在VO2变为氧供应依赖之前就损害了全身氧摄取,这可能是由于包括内脏循环在内的血流分布不均所致。