Porta F, Takala J, Kolarova A, Ma Y, Redaelli C A, Brander L, Bracht H, Jakob S M
Surgical Research Unit, Dept. of Clinical Research and Clinic for Large Animals, University of Berne, CH-3010 Berne, Switzerland.
Acta Anaesthesiol Scand. 2005 May;49(5):627-34. doi: 10.1111/j.1399-6576.2005.00683.x.
Sepsis may impair O(2) extraction due to blood flow redistribution or decreased utilization of the available oxygen.
We assessed the effect of endotoxemia on systemic and regional O(2) extraction and lactate handling in pigs, randomized to receive either endotoxin (0.4 microg kg(-1) h(-1); n = 10) or saline infusion (controls; n = 9) for 12 h.
High baseline regional and systemic O(2) extraction in the endotoxin group (median 56%, range 45-77%) and in the controls (67%, 49-72%) was maintained until the end of the experiment (endotoxin group: 60%, 50-71%; controls: 60%, 50-74%) despite hypotension and a decrease in stroke volume in endotoxic animals. Hepatic lactate exchange decreased during endotoxemia from 14 micromol kg(-1) min(-1) (range 10-28 micromol kg(-1) min(-1)) to 10 (range 3-15) micromol kg(-1) min(-1); P < 0.01), but remained stable in the controls, with 13 micromol min(-1) (4-18 micromol min(-1)) at baseline and 7 micromol min(-1) (3-17 micromol min(-1)) after 12 h of saline infusion.
The high and sustained oxygen consumption and oxygen extraction in this endotoxemic model speak against any major impairment of hepatosplanchnic or systemic oxygen extraction and oxidative metabolism. The reduced hepatic lactate exchange despite an unchanged hepatic lactate influx suggests altered metabolic activities independent of oxygen consumption.
脓毒症可能由于血流重新分布或可用氧利用减少而损害氧提取。
我们评估了内毒素血症对猪全身和局部氧提取及乳酸处理的影响，将猪随机分为两组，一组接受内毒素输注（0.4微克/千克/小时；n = 10），另一组接受生理盐水输注（对照组；n = 9），持续12小时。
内毒素组（中位数56%，范围45 - 77%）和对照组（67%，49 - 72%）较高的基线局部和全身氧提取在实验结束时仍得以维持（内毒素组：60%，50 - 71%；对照组：60%，50 - 74%），尽管内毒素血症动物出现低血压和每搏输出量下降。内毒素血症期间肝脏乳酸交换从14微摩尔/千克/分钟（范围10 - 28微摩尔/千克/分钟）降至10（范围3 - 15）微摩尔/千克/分钟；P < 0.01），但对照组保持稳定，基线时为13微摩尔/分钟（4 - 18微摩尔/分钟），生理盐水输注12小时后为7微摩尔/分钟（3 - 17微摩尔/分钟）。
在这个内毒素血症模型中，高且持续的氧消耗和氧提取表明肝内脏或全身氧提取及氧化代谢未受到重大损害。尽管肝脏乳酸流入未变，但肝脏乳酸交换减少，这表明代谢活动发生了改变，且与氧消耗无关。
