Morita Yoshihisa, Chin-Yee Ian, Yu Pei, Sibbald William J, Martin Claudio M
London Health Sciences Centre, 375 South Street, London, ON, Canada N6A 4G5.
Am J Respir Crit Care Med. 2003 Mar 15;167(6):868-72. doi: 10.1164/rccm.200205-490OC. Epub 2002 Dec 12.
Although evidence shows that critical O2 delivery (QO2crit), the point at which oxygen consumption becomes limited by O2 delivery (QO2), is not affected by the method used to decrease QO2 in healthy subjects, microcirculatory injury caused by sepsis may modify QO2crit in a unique manner. We therefore designed this study to compare QO2crit in anemic and stagnant hypoxia in conscious septic rats. Rats were randomized to control or sepsis induced by cecal ligation and perforation; 24 hours later, oxygen consumption was measured using expired gas analysis, whereas QO2 was calculated from standard formula. Rats were further randomized to anemic hypoxia by isovolemic hemodilution or stagnant hypoxia by stepwise inflation of a balloon-tip catheter in the right atrium. QO2crit and critical hemoglobin concentration were calculated by dual linear regression analysis. We found that (1) QO2crit was not different between anemic and stagnant hypoxia in sepsis and that (2) the critical hemoglobin concentration in anemic hypoxia was similar between sepsis and control, indicating that tolerance to acute anemia is not altered by sepsis. Further studies are needed before the clinical relevance of these conclusions can be fully understood.
尽管有证据表明,在健康受试者中,临界氧输送(QO2crit)(即氧消耗受氧输送(QO2)限制的点)不受用于降低QO2的方法的影响,但脓毒症引起的微循环损伤可能以独特的方式改变QO2crit。因此,我们设计了这项研究,以比较清醒脓毒症大鼠贫血性缺氧和淤滞性缺氧时的QO2crit。将大鼠随机分为对照组或通过盲肠结扎和穿孔诱导脓毒症组;24小时后,使用呼出气体分析测量氧消耗,而QO2则根据标准公式计算。通过等容血液稀释使大鼠进一步随机分为贫血性缺氧组,或通过在右心房逐步充盈球囊尖端导管使大鼠分为淤滞性缺氧组。通过双线性回归分析计算QO2crit和临界血红蛋白浓度。我们发现:(1)脓毒症时贫血性缺氧和淤滞性缺氧的QO2crit无差异;(2)脓毒症组和对照组贫血性缺氧时的临界血红蛋白浓度相似,表明脓毒症不会改变对急性贫血的耐受性。在这些结论的临床相关性得到充分理解之前,还需要进一步的研究。