Kang Hyun, Manasia Anthony, Rajamani Sridhar, Rajaram Sri-Sujanthy, Hannon Emily, Lu Yongzhi, Oropello John M, Benjamin Ernest
Department of Surgery, The Mount Sinai Medical Center, City University of New York, NY 10029, USA.
Crit Care Med. 2002 Nov;30(11):2528-34. doi: 10.1097/00003246-200211000-00021.
To evaluate the effect of an intravenously administered synthetic epoprostenol analog, iloprost, in nonocclusive acute mesenteric ischemia induced by cardiac tamponade.
Prospective, randomized, controlled experimental study.
Animal research laboratory at a university medical center.
Ten Yorkshire pigs (weight range, 20-25 kg).
Nonocclusive acute mesenteric ischemia was induced by pericardial tamponade. Pigs were randomized to receive either a low-dose, continuous intravenous infusion of iloprost (0.075 microg/kg/min) or an equivalent volume of normal saline to serve as the control. Infusion of iloprost or saline was continued after pericardial tamponade was reversed.
Ten anesthetized and ventilated pigs underwent laparotomy and thoracotomy. A pulmonary artery catheter was inserted, a magnetic flow probe was positioned around the superior mesenteric artery (SMA), and cannulation of the pericardial space was performed. Pericardial tamponade was induced by injecting 5% dextrose in water into the pericardial space until blood flow in the superior mesenteric artery decreased to half of baseline. After 60 mins, animals received either a continuous intravenous infusion of iloprost at 0.075 microg/kg/min (n = 6) or an equal volume of normal saline (n = 4) for 60 mins. Pericardial fluid was then removed, and iloprost or normal saline infusion was continued for another 60 mins.
Heart rate, blood pressure, cardiac output, oxygen delivery, oxygen consumption, SMA blood flow, ileal Pco2, ileal intramucosal pH, and serum lactate levels of mixed venous blood and mesenteric venous blood were recorded at baseline, after pericardial tamponade was induced, during the iloprost or normal saline infusion with pericardial tamponade, and after removal of pericardial fluid (reperfusion period).
Iloprost infusion increased SMA blood flow by 60% in this model of nonocclusive mesenteric ischemia (from 168 +/- 41 to 269 +/- 76 mL/min; p <.05). The effect of iloprost infusion was more prominent after the tamponade (422 +/- 87 mL/min in the iloprost group vs. 232 +/- 111 mL/min in the control group; p <.05). Increased mesenteric perfusion decreased intestinal mucosal hypercarbia, leading to improvement of intramucosal pH.
评估静脉注射合成前列环素类似物伊洛前列素对心脏压塞所致非闭塞性急性肠系膜缺血的影响。
前瞻性、随机、对照实验研究。
大学医学中心的动物研究实验室。
10只约克夏猪（体重范围20 - 25千克）。
通过心包压塞诱导非闭塞性急性肠系膜缺血。猪被随机分为两组，分别接受低剂量、持续静脉输注伊洛前列素（0.075微克/千克/分钟）或等量生理盐水作为对照。心包压塞解除后继续输注伊洛前列素或生理盐水。
10只麻醉并通气的猪接受剖腹术和开胸术。插入肺动脉导管，在肠系膜上动脉周围放置磁流量探头，并进行心包腔插管。通过向心包腔内注入5%葡萄糖溶液诱导心包压塞，直至肠系膜上动脉血流降至基线的一半。60分钟后，动物接受持续静脉输注伊洛前列素（0.075微克/千克/分钟，n = 6）或等量生理盐水（n = 4），持续60分钟。然后抽出心包积液，继续输注伊洛前列素或生理盐水60分钟。
在基线、诱导心包压塞后、心包压塞时输注伊洛前列素或生理盐水期间以及抽出心包积液后（再灌注期），记录心率、血压、心输出量、氧输送、氧消耗、肠系膜上动脉血流、回肠Pco2、回肠黏膜内pH以及混合静脉血和肠系膜静脉血的血清乳酸水平。
在该非闭塞性肠系膜缺血模型中，输注伊洛前列素使肠系膜上动脉血流增加60%（从168±41毫升/分钟增至269±76毫升/分钟；p<.05）。心包压塞后伊洛前列素输注的效果更显著（伊洛前列素组为422±87毫升/分钟，对照组为232±111毫升/分钟；p<.05）。肠系膜灌注增加降低了肠黏膜高碳酸血症，导致黏膜内pH改善。
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