Knotzer H, Pajk W, Maier S, Ladurner R, Kleinsasser A, Wenzel V, Dünser M W, Ulmer H, Hasibeder W R
Dept. of Anesthesiology and Critical Care Medicine, Innsbruck Medical Univ., Anichstrasse 35, 6020 Innsbruck, Austria.
Am J Physiol Heart Circ Physiol. 2005 Jul;289(1):H168-73. doi: 10.1152/ajpheart.01235.2004. Epub 2005 Mar 11.
We investigated intestinal oxygen supply and mucosal tissue PO2 during administration of increasing dosages of continuously infused arginine vasopressin (AVP) in an autoperfused, innervated jejunal segments in anesthetized pigs. Mucosal tissue PO2 was measured by employing two Clark-type surface oxygen electrodes. Oxygen saturation of jejunal microvascular hemoglobin was determined by tissue reflectance spectrophotometry. Microvascular blood flow was assessed by laser-Doppler velocimetry. Systemic hemodynamic variables, mesenteric venous and systemic acid-base and blood gas variables, and lactate measurements were recorded. Measurements were performed at baseline and at 20-min intervals during incremental AVP infusion (n = 8; 0.007, 0.014, 0.029, 0.057, 0.114, and 0.229 IU.kg(-1).h(-1), respectively) or infusion of saline (n=8). AVP infusion led to a significant (P < .05), dose-dependent decrease in cardiac index (from 121 +/- 31 to 77 +/- 27 ml.kg(-1).min(-1) at 0.229 IU.kg(-1).h(-1)) and systemic oxygen delivery (from 14 +/- 3 to 9 +/- 3 ml.kg(-1).min(-1) at 0.229 IU.kg(-1).h(-1)) concomitant with an increase in systemic oxygen extraction ratio (from 31 +/- 4 to 48 +/- 10%). AVP decreased microvascular blood flow (from 133 +/- 47 to 82 +/- 35 perfusion units at 0.114 IU.kg(-1).h(-1)), mucosal tissue PO2 (from 26 +/- 7 to 7 +/- 2 mmHg at 0.229 IU.kg(-1).h(-1)), and microvascular hemoglobin oxygen saturation (from 51 +/- 9 to 26 +/- 12% at 0.229 IU.kg(-1).h(-1)) without a significant increase in mesenteric venous lactate concentration (2.3 +/- 0.8 vs. 3.4 +/- 0.7 mmol/l). We conclude that continuously infused AVP decreases intestinal oxygen supply and mucosal tissue PO2 due to a reduction in microvascular blood flow and due to the special vascular supply in the jejunal mucosa in a dose-dependent manner in pigs.
我们在麻醉猪的自灌注、有神经支配的空肠段中,研究了持续输注不同剂量精氨酸加压素(AVP)期间的肠道氧气供应和黏膜组织氧分压。采用两个克拉克型表面氧电极测量黏膜组织氧分压。通过组织反射分光光度法测定空肠微血管血红蛋白的氧饱和度。用激光多普勒测速仪评估微血管血流量。记录全身血流动力学变量、肠系膜静脉及全身酸碱和血气变量以及乳酸测量值。在基线时以及在递增AVP输注期间(n = 8;分别为0.007、0.014、0.029、0.057、0.114和0.229 IU·kg⁻¹·h⁻¹)或输注生理盐水期间(n = 8),每隔20分钟进行一次测量。AVP输注导致心脏指数显著(P < 0.05)、剂量依赖性降低(在0.229 IU·kg⁻¹·h⁻¹时从121 ± 31降至77 ± 27 ml·kg⁻¹·min⁻¹)以及全身氧输送降低(在0.229 IU·kg⁻¹·h⁻¹时从14 ± 3降至9 ± 3 ml·kg⁻¹·min⁻¹),同时全身氧摄取率增加(从31 ± 4增至48 ± 10%)。AVP降低了微血管血流量(在0.114 IU·kg⁻¹·h⁻¹时从133 ± 47降至82 ± 35灌注单位)、黏膜组织氧分压(在0.229 IU·kg⁻¹·h⁻¹时从26 ± 7降至7 ± 2 mmHg)以及微血管血红蛋白氧饱和度(在0.229 IU·kg⁻¹·h⁻¹时从51 ± 9降至26 ± 12%),而肠系膜静脉乳酸浓度无显著增加(2.3 ± 0.8 vs. 3.4 ± 0.7 mmol/l)。我们得出结论,在猪中,持续输注AVP会因微血管血流量减少以及空肠黏膜特殊的血管供应,以剂量依赖性方式降低肠道氧气供应和黏膜组织氧分压。