用微透析和氧运输变量评估低剂量前列环素对内毒素血症期间猫肠道灌注的有益作用。

Beneficial effects of low-dose prostacyclin on cat intestinal perfusion during endotoxemia as evaluated with microdialysis and oxygen transport variables.

作者信息

Möller A D, Grände P O

机构信息

Department of Anesthesia and Intensive Care, University and University Hospital of Lund, Lund, Sweden.

出版信息

Crit Care Med. 2001 Feb;29(2):351-8. doi: 10.1097/00003246-200102000-00025.

DOI:10.1097/00003246-200102000-00025

PMID:11246316

Abstract

OBJECTIVE

To evaluate the effects of low-dose prostacyclin on intestinal perfusion during endotoxemia.

DESIGN

A randomized, blinded experimental study.

SETTING

A university laboratory.

SUBJECTS

Sixteen anesthetized cats.

INTERVENTIONS

The animals received endotoxin by continuous intravenous infusion (0.5 mg/kg plus 0.5 mg x kg(-1) x hr(-1)) and a continuous volume replacement throughout the experiment. Four hours after the start of endotoxin, the animals were randomized to receive an infusion of either prostacyclin at a dose of 1 ng x kg(-1) x min(-1) (prostacyclin group) or vehicle (control group) during the next 4 hrs.

MEASUREMENTS AND MAIN RESULTS

Intestinal vascular resistance was calculated from systemic arterial pressure, central venous pressure, and superior mesenteric artery blood flow, and intestinal oxygen delivery and uptake were calculated from superior mesenteric artery and vein blood samples and blood flow. Interstitial lactate, pyruvate, glucose, and glycerol in the ileal wall were measured by using microdialysis. There were no differences in baseline values between the groups. Systemic blood pressure decreased initially but recovered and remained stable in both groups. In the control group, intestinal vascular resistance increased from 10.9 +/- 1.0 to 24.7 +/- 5.3 mm Hg x mL x min(-1) x kg(-1) (p <.05) at 8 hrs, and oxygen delivery decreased from 2.6 +/- 0.2 to 1.3 +/- 0.3 mL x min(-1) x kg(-1) (p <.05). Simultaneously, microdialysis lactate increased from 1.6 +/- 0.1 to 3.6 +/- 0.5 mmol/L (p <.05) with concomitant pyruvate increase and unchanged lactate/pyruvate ratio. Blood lactate increased and pH decreased. In the prostacyclin group at 8 hrs, intestinal vascular resistance of 6.9 +/- 0.8 mm Hg x mL x min(-1) x kg(-1) was lower and intestinal oxygen delivery of 3.2 +/- 0.3 was higher (p <.05) than in the control group at 8 hrs. Intestinal oxygen uptake of 0.54 +/- 0.10 mL x min(-1) x kg(-1) was higher than in the control group, in which oxygen uptake was 0.26 +/- 0.04 mL x min(-1) x kg(-1). Lactate, pyruvate, and pH were normalized at 8 hrs in the prostacyclin group.

CONCLUSION

Low-dose prostacyclin has beneficial effects on small intestinal perfusion during endotoxemia in this experimental cat model.

摘要

目的

评估低剂量前列环素对内毒素血症期间肠道灌注的影响。

设计

一项随机、盲法实验研究。

设置

大学实验室。

对象

16只麻醉猫。

干预措施

动物通过持续静脉输注接受内毒素（0.5mg/kg加0.5mg·kg⁻¹·hr⁻¹），并在整个实验过程中持续进行容量置换。内毒素开始输注4小时后，动物被随机分为在接下来4小时内接受剂量为1ng·kg⁻¹·min⁻¹的前列环素输注（前列环素组）或赋形剂（对照组）。

测量指标及主要结果

根据体动脉压、中心静脉压和肠系膜上动脉血流量计算肠道血管阻力，根据肠系膜上动脉和静脉血样本及血流量计算肠道氧输送和摄取。通过微透析测量回肠壁间质中的乳酸、丙酮酸、葡萄糖和甘油。两组间基线值无差异。两组全身血压最初均下降，但随后恢复并保持稳定。在对照组中，8小时时肠道血管阻力从10.9±1.0增加至24.7±5.3mmHg·mL·min⁻¹·kg⁻¹（p<0.05），氧输送从2.6±0.2降至1.3±0.3mL·min⁻¹·kg⁻¹（p<0.05）。同时，微透析乳酸从1.6±0.1增加至3.6±0.5mmol/L（p<0.05），丙酮酸增加，乳酸/丙酮酸比值不变。血乳酸增加，pH值下降。在前列环素组8小时时，肠道血管阻力为6.9±0.8mmHg·mL·min⁻¹·kg⁻¹低于对照组，肠道氧输送为3.2±0.3高于对照组8小时时的值（p<0.05）。肠道氧摄取为0.54±0.10mL·min⁻¹·kg⁻¹高于对照组，对照组氧摄取为0.26±0.04mL·min⁻¹·kg⁻¹。前列环素组8小时时乳酸、丙酮酸和pH值恢复正常。