Campbell James E, Garrison Richard N, Zakaria El Rasheid
Department of Physiology, University of Louisville, Louisville, KY, USA.
Am J Surg. 2006 Nov;192(5):610-6. doi: 10.1016/j.amjsurg.2006.08.016.
Hemorrhagic shock (HS) with conventional resuscitation (CR) (HSCR) primes neutrophils and modulates leukocyte (WBC)-endothelium interaction as part of an exaggerated systemic inflammatory response. We hypothesize that topical application of clinical peritoneal dialysis solutions (PD) modulates such interaction.
Intestinal intravital microscopy was used to measure WBC rolling in terminal ileum post capillary venules (V2 and V3) in sham-operated animals, and in animals that underwent fixed pressure hemorrhage (50% mean arterial pressure for 60 minutes), followed by conventional resuscitation with the return of the shed blood and 2 vol of saline. Number of rolling WBCs per thirty seconds in selected V2 and V3, bathed in either Kreb's solution or a 2.5% clinical peritoneal dialysis solution (PD) was quantified. Diameters were measured for the in-flow arterioles (A1), and out-flow venules (V1), for calculation of local blood flow with optical Doppler velocimetry.
The PD solution significantly (P < .05, n = 11) attenuated WBC-endothelium interaction in sham-operated animals while no significant difference was elicited in HSCR (P > .05, n = 9 Kreb's, n = 7 PD). In addition, the PD solution produced an instantaneous dilation at all levels of the intestinal arterioles in both sham and HSCR. While intestinal venular blood outflow was increased by the PD solution, venular diameters changed very little.
Superfusion of the gut with glucose-based peritoneal dialysis solutions decreases the concentration of rolling leukocytes along the venular vascular endothelium by a vasodilation-mediated increase in arteriolar inflow and venous outflow mechanism. Hemorrhagic shock and conventional resuscitation enhance the concentration of rolling leukocytes presumably by mechanisms related to upregulation of the adhesion molecules and the low-flow state. Hemorrhage and resuscitation-enhanced leukocytes rolling was not reversed by adjunctive DPR despite the associated marked increase in arterial inflow and venous outflow. The status of the endothelium and the level of leukocyte priming in low-flow states are stronger predictors of leukocyte-endothelium interaction than rheology factors.
传统复苏（CR）的失血性休克（HS）（HSCR）会使中性粒细胞致敏，并调节白细胞（WBC）与内皮的相互作用，这是过度全身性炎症反应的一部分。我们假设临床腹膜透析液（PD）的局部应用可调节这种相互作用。
采用肠道活体显微镜测量假手术动物以及经历固定压力出血（平均动脉压的50%，持续60分钟）后进行传统复苏（回输 shed blood 并输注2倍体积生理盐水）的动物回肠末端毛细血管后微静脉（V2和V3）中的白细胞滚动情况。对浸泡在 Krebs 溶液或2.5%临床腹膜透析液（PD）中的选定V2和V3中每30秒滚动的白细胞数量进行量化。用光学多普勒测速仪测量流入小动脉（A1）和流出微静脉（V1）的直径，以计算局部血流量。
PD溶液在假手术动物中显著（P <.05，n = 11）减弱了白细胞与内皮的相互作用，而在HSCR中未引起显著差异（P >.05，n = 9使用Krebs溶液，n = 7使用PD溶液）。此外，PD溶液在假手术和HSCR的所有肠道小动脉水平均产生了瞬时扩张。虽然PD溶液增加了肠道微静脉的血液流出，但微静脉直径变化很小。
用基于葡萄糖的腹膜透析液灌注肠道，通过血管舒张介导的小动脉流入和静脉流出机制增加，降低了沿微静脉血管内皮滚动的白细胞浓度。失血性休克和传统复苏可能通过与黏附分子上调和低流量状态相关的机制增加滚动白细胞的浓度。尽管辅助性DPR使动脉流入和静脉流出显著增加，但出血和复苏增强的白细胞滚动并未被逆转。在低流量状态下，内皮状态和白细胞致敏水平比流变学因素更能预测白细胞与内皮的相互作用。
