Schäper Jörn, Ahmed Raees, Schäfer Tobias, Elster Antje, Enigk Fabian, Habazettl Helmut, Mousa Shaaban, Schäfer Michael, Welte Martin
Department of Anesthesiology and Critical Care Medicine, Charité-Universitätsmedizin Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, 12203 Berlin, Germany.
Resuscitation. 2008 Jan;76(1):120-8. doi: 10.1016/j.resuscitation.2007.06.026. Epub 2007 Aug 13.
Colloid solutions have been suggested to improve microvascular perfusion due to their anti-inflammatory properties. Whether this also applies for the gut, an important immunological organ vulnerable to hypoperfusion is unknown. This study investigated intestinal microcirculation of endotoxaemic rats after volume therapy with colloid solutions such as hydroxyethyl starch (HES) and gelatin or isotonic saline (NaCl). In addition intestinal oxygenation and morphology as well as mesenteric leukocyte-endothelium interaction were quantified. Rats were anaesthetised with urethane and ketamine, mechanically ventilated, and monitored haemodynamically. Normotensive endotoxaemia was induced by a continuous intravenous infusion of Escherichia coli lipopolysaccharide (LPS, 1.5 mg kg(-1) h(-1)). After 1 h of LPS infusion either 6% HES (16 ml kg(-1)), 4% gelatin (16 ml kg(-1)) or 0.9% NaCl (64 ml kg(-1)) were infused for 1 h. Using intravital microscopy, functional capillary density (FCD) and red blood cell velocity (RBCV) were measured in the mucosa of the terminal ileum at baseline and 3 h after volume therapy. In another set of animals, mesenteric leukocyte-endothelium interaction was determined 3 h after volume therapy. In all animals intestinal lactate/pyruvate ratio and intestinal morphology were assessed. Three hours after volume therapy, FCD decreased in NaCl (808 [749/843] cm(-1); median [quartiles] P<0.05 versus baseline) but not in HES (995 [945/1036] cm(-1)) and gelatin (988 [867/1193] cm(-1)) groups. RBCV, lactate/pyruvate ratio and intestinal morphology did not differ among groups. Also mesenteric leukocyte-endothelium interaction was not significantly influenced by either treatment. In conclusion, early volume therapy with HES or gelatin, but not with NaCl, preserved gut microvascular perfusion during endotoxaemia but did not have a significant effect on tissue oxygenation nor morphological appearance in this experimental model. An anti-inflammatory effect of colloid solutions was not seen and fails to explain the changes in intestinal microcirculation.
胶体溶液因其抗炎特性被认为可改善微血管灌注。这是否也适用于肠道这个易受灌注不足影响的重要免疫器官尚不清楚。本研究调查了用羟乙基淀粉（HES）和明胶等胶体溶液或等渗盐水（NaCl）进行容量治疗后内毒素血症大鼠的肠道微循环。此外，还对肠道氧合、形态以及肠系膜白细胞与内皮细胞的相互作用进行了量化。大鼠用乌拉坦和氯胺酮麻醉，进行机械通气，并进行血流动力学监测。通过持续静脉输注大肠杆菌脂多糖（LPS，1.5 mg kg⁻¹ h⁻¹）诱导正常血压内毒素血症。在输注LPS 1小时后，输注6% HES（16 ml kg⁻¹）、4%明胶（16 ml kg⁻¹）或0.9% NaCl（64 ml kg⁻¹）1小时。使用活体显微镜，在容量治疗前和治疗后3小时测量回肠末端黏膜的功能性毛细血管密度（FCD）和红细胞速度（RBCV）。在另一组动物中，在容量治疗后3小时测定肠系膜白细胞与内皮细胞的相互作用。在所有动物中评估肠道乳酸/丙酮酸比值和肠道形态。容量治疗3小时后，NaCl组的FCD降低（808 [749/843] cm⁻¹；中位数[四分位数]与基线相比P<0.05），而HES组（995 [945/1036] cm⁻¹）和明胶组（988 [867/1193] cm⁻¹）未降低。各组之间的RBCV、乳酸/丙酮酸比值和肠道形态无差异。同样，肠系膜白细胞与内皮细胞的相互作用也未受到任何一种治疗的显著影响。总之，在内毒素血症期间，早期用HES或明胶而非NaCl进行容量治疗可维持肠道微血管灌注，但在该实验模型中对组织氧合和形态外观没有显著影响。未观察到胶体溶液的抗炎作用，也无法解释肠道微循环的变化。
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