Garrido A G, Poli de Figueiredo L F, Cruz R J, Silva E, Rocha E Silva M
Serviço de Fisiologia aplicada, InCor, Hospital das Clínicas, Universidade de São Paulo, SP, Brasil.
Braz J Med Biol Res. 2005 Jun;38(6):873-84. doi: 10.1590/s0100-879x2005000600009. Epub 2005 Jun 1.
We investigated the systemic and regional hemodynamic effects of early crystalloid infusion in an experimental model of septic shock induced by intravenous inoculation with live Escherichia coli. Anesthetized dogs received an intravenous infusion of 1.2 x 10(10) cfu/kg live E. coli in 30 min. After 30 min of observation, they were randomized to controls (no fluids; N = 7), or fluid resuscitation with lactated Ringer's solution, 16 ml/kg (N = 7) or 32 ml/kg (N = 7) over 30 min and followed for 120 min. Cardiac index, portal blood flow, mean arterial pressure, systemic and regional oxygen-derived variables, blood lactate, and gastric PCO2 were assessed. Rapid and progressive cardiovascular deterioration with reduction in cardiac output, mean arterial pressure and portal blood flow (approximately 50, approximately 25 and approximately 70%, respectively) was induced by the live bacteria challenge. Systemic and regional territories showed significant increases in oxygen extraction and in lactate levels. Significant increases in venous-arterial (approximately 9.6 mmHg), portal-arterial (approximately 12.1 mmHg) and gastric mucosal-arterial (approximately 18.4 mmHg) PCO2 gradients were also observed. Early fluid replacement, especially with 32 ml/kg volumes of crystalloids, promoted only partial and transient benefits such as increases of approximately 76% in cardiac index, of approximately 50% in portal vein blood flow and decreases in venous-arterial, portal-arterial, gastric mucosal-arterial PCO2 gradients (7.2 +/- 1.0, 7.2 +/- 1.3 and 9.7 +/- 2.5 mmHg, respectively). The fluid infusion promoted only modest and transient benefits, unable to restore the systemic and regional perfusional and metabolic changes in this hypodynamic septic shock model.
我们在静脉注射活大肠杆菌诱导的脓毒性休克实验模型中，研究了早期晶体液输注对全身和局部血流动力学的影响。麻醉后的犬在30分钟内静脉输注1.2×10¹⁰ cfu/kg活大肠杆菌。观察30分钟后，将它们随机分为对照组（不输液；n = 7），或在30分钟内用乳酸林格氏液进行液体复苏，剂量为16 ml/kg（n = 7）或32 ml/kg（n = 7），并持续观察120分钟。评估心脏指数、门静脉血流量、平均动脉压、全身和局部氧衍生变量、血乳酸和胃PCO₂。活菌攻击导致快速且进行性的心血管恶化，心输出量、平均动脉压和门静脉血流量分别降低约50%、约25%和约70%。全身和局部区域的氧摄取和乳酸水平显著升高。还观察到静脉-动脉（约9.6 mmHg）、门静脉-动脉（约12.1 mmHg）和胃黏膜-动脉（约18.4 mmHg）PCO₂梯度显著增加。早期液体补充，尤其是32 ml/kg剂量的晶体液，仅带来部分和短暂的益处，如心脏指数增加约76%、门静脉血流量增加约50%，以及静脉-动脉、门静脉-动脉、胃黏膜-动脉PCO₂梯度降低（分别为7.2±1.0、7.2±1.3和9.7±2.5 mmHg）。在这个低动力性脓毒性休克模型中，液体输注仅带来适度和短暂的益处，无法恢复全身和局部的灌注及代谢变化。
