Venkatesh Bala, Morgan Thomas J, Hall Jonathan, Endre Zolton, Willgoss Desley
Department of Intensive Care, University of Queensland, Princess Alexandra Hospital, Woolloongabba and Wesley Hospital, Australia.
Intensive Care Med. 2005 Mar;31(3):447-53. doi: 10.1007/s00134-005-2558-8. Epub 2005 Feb 10.
Few comparative data exist on the responses of the subcutaneous and splanchnic circulations to evolving endotoxic shock. We therefore compared continuous subcutaneous pO(2) (pO(2sc)) and pCO(2) (pCO(2sc)) with simultaneous continuous gut luminal pCO(2) (pCO(2gi)) in an animal model of endotoxaemia and examined whether changes in gas tensions track tissue energy charge (EC).
Prospective observational study.
Fourteen anaesthetized rats, 7 controls and 7 experimental.
Controls were injected with saline, the experimental group with 20 mg/kg Klebsiella endotoxin. pCO(2sc), pO(2sc), and pCO(2gi) were measured continuously. Plasma lactate concentrations were measured at defined periods during the study. After 2 h ileal segments were snap frozen and assayed for tissue EC.
Endotoxaemia resulted in a significant decrease in mean arterial blood pressure (132+/-9 to 71+/-20 mmHg) and pO(2sc) (71+/-23 to 33+/-22 torr) and a significant increase in pCO(2gi) (58+/-10 to 90+/-20 torr) and pCO(2sc) (56+/-6 to 81+/-25 torr). During endotoxaemia pCO(2gi) was directly correlated with pCO(2sc) (R (2)=0.5) and inversely correlated with pO(2sc) (R (2)=0.63). Plasma lactate concentrations were significantly elevated from baseline in the endotoxin limb. The mean EC was not significantly different in the two groups.
Both subcutaneous tissue gas tensions and intestinal luminal carbon dioxide tensions are rapidly responsive during evolving hypodynamic endotoxic shock. Alterations in tissue gas tensions were not associated with dysoxia.
关于皮下和内脏循环对进展性内毒素休克反应的比较数据很少。因此,我们在动物内毒素血症模型中比较了连续皮下氧分压(pO₂sc)和二氧化碳分压(pCO₂sc)与同时连续的肠腔内二氧化碳分压(pCO₂gi),并研究气体张力的变化是否跟踪组织能荷(EC)。
前瞻性观察研究。
14只麻醉大鼠,7只为对照组,7只为实验组。
对照组注射生理盐水,实验组注射20mg/kg克雷伯菌内毒素。连续测量pCO₂sc、pO₂sc和pCO₂gi。在研究期间的特定时间段测量血浆乳酸浓度。2小时后将回肠段速冻并测定组织能荷。
内毒素血症导致平均动脉血压显著下降(从132±9降至71±20mmHg)和pO₂sc显著下降(从71±23降至33±22托),pCO₂gi显著升高(从58±10升至90±20托)和pCO₂sc显著升高(从56±6升至81±25托)。在内毒素血症期间,pCO₂gi与pCO₂sc直接相关(R² = 0.5),与pO₂sc呈负相关(R² = 0.63)。内毒素组血浆乳酸浓度较基线显著升高。两组的平均能荷无显著差异。
在进展性低动力性内毒素休克期间,皮下组织气体张力和肠腔内二氧化碳张力均迅速反应。组织气体张力的改变与缺氧无关。