Knuesel Rafael, Jakob Stephan M, Brander Lukas, Bracht Hendrik, Siegenthaler Andreas, Takala Jukka
Department of Intensive Care Medicine, Inselspital, University Hospital Berne, 3010, Berne, Switzerland.
Intensive Care Med. 2003 Dec;29(12):2255-2265. doi: 10.1007/s00134-003-1954-1. Epub 2003 Sep 17.
pCO(2) gradients are used for the assessment of splanchnic regional and local mucosal blood flow changes in experimental and clinical research. pCO(2) gradients may not parallel blood flow changes because of concomitant changes in metabolism, hemoglobin, temperature, and the Haldane effect.
A randomized, controlled animal experiment in a university experimental research laboratory.
An extracorporeal shunt with reservoir and roller pump was inserted between the proximal and the distal abdominal aorta in 16 pigs. In animals randomized to the low-flow group ( n=8) splanchnic perfusion was reduced by running the roller pump. At baseline and after 45 min of stable shunt flow superior mesenteric artery, celiac trunk, spleen artery, and portal vein blood flows and regional venous-arterial and jejunal and gastric mucosal-arterial pCO(2) gradients were measured, and the respective regional O(2) consumption rates (VO(2)) calculated.
In the low-flow group all regional blood flows and the associated VO(2) decreased to roughly 50% of baseline values, and hemoglobin decreased from 7.3 (4.4-9.6) g/dl to 5.7 (4.1-8.9) g/dl. Decreasing regional blood flows were consistently associated with increasing regional and mucosal pCO(2) gradients.
During isolated reduction in abdominal aortic blood flow there is no preferential distribution to any splanchnic vascular bed and changes in regional pCO(2) gradients reflect consistently the associated blood blow changes.
在实验和临床研究中,pCO₂梯度用于评估内脏区域和局部黏膜血流变化。由于代谢、血红蛋白、温度和哈氏效应的伴随变化,pCO₂梯度可能与血流变化不平行。
在大学实验研究实验室进行的一项随机对照动物实验。
在16头猪的腹主动脉近端和远端之间插入带有储液器和滚轴泵的体外分流器。在随机分配到低流量组(n = 8)的动物中,通过运行滚轴泵来减少内脏灌注。在基线时以及分流稳定45分钟后,测量肠系膜上动脉、腹腔干、脾动脉和门静脉血流以及区域静脉-动脉和空肠及胃黏膜-动脉pCO₂梯度,并计算各自的区域氧消耗率(VO₂)。
在低流量组中,所有区域血流和相关的VO₂降至基线值的约50%,血红蛋白从7.3(4.4 - 9.6)g/dl降至5.7(4.1 - 8.9)g/dl。区域血流的减少始终与区域和黏膜pCO₂梯度的增加相关。
在腹主动脉血流单独减少期间,没有优先分布到任何内脏血管床,区域pCO₂梯度的变化始终反映相关的血流变化。