Clavijo Julio A, van Bastelaar James, Pinsky Michael R, Puyana Juan Carlos, Mayevsky Avraham
Department of Critical Care Medicine and Surgery, University of Pittsburgh Medical Center, Presbyterian Hospital, Pittsburgh, PA, USA.
Med Sci Monit. 2008 Sep;14(9):BR175-82.
The ideal endpoint of resuscitation after severe hemorrhage should indicate not only that optimal oxygen delivery has been achieved, but also that oxygen utilization has been restored. A modified Foley catheter for simultaneous assessment of microcirculatory blood flow (TBF) and mitochondrial NADH in the urethral wall was used in the female swine. We hypothesized that changes in mitochondrial NADH and TBF are associated with impaired energy metabolism in the urethra and that these changes correlate with impaired tissue perfusion in the bladder during shock and resuscitation.
MATERIAL/METHODS: Female swine n=5 underwent laparotomy. TBF was measured by a laser Doppler flowmeter. Mitochondrial function was evaluated by measuring NADH fluorescence in vivo. Multiparameter sensors (pH, pCO2 and pO2) were placed in the bladder mucosa (BM), and in the skeletal muscle (Sk). Animals underwent hemorrhage and their MAP was maintained at 40 mm Hg by appropriate infusing or withdrawing of blood for 10 min. Animals were resuscitated and observed for 20 min.
Urethral NADH increased during shock and recovered during resuscitation, while TBF showed an opposite effect (r(2)=0.74). Skeletal muscle and bladder pO2 decreased during shock (p<0.01) and recovered after resuscitation. NADH increased significantly (p<0.05) during shock and decreased after resuscitation.
Changes in TBF and NADH in the urethral mucosa represent novel markers for the energetic state of the tissue. They could be measured in vivo by a minimally invasive approach and thus could provide important information on the end-points of resuscitation in hemorrhagic shock.
严重出血后复苏的理想终点不仅应表明已实现最佳氧输送，还应表明氧利用已恢复。在雌性猪中使用了一种改良的Foley导管，用于同时评估尿道壁的微循环血流量（TBF）和线粒体NADH。我们假设线粒体NADH和TBF的变化与尿道能量代谢受损有关，并且这些变化与休克和复苏期间膀胱组织灌注受损相关。
材料/方法：5只雌性猪接受剖腹手术。用激光多普勒流量计测量TBF。通过测量体内NADH荧光评估线粒体功能。将多参数传感器（pH、pCO2和pO2）放置在膀胱黏膜（BM）和骨骼肌（Sk）中。动物进行出血，通过适当输注或抽取血液将其平均动脉压维持在40 mmHg 10分钟。动物进行复苏并观察20分钟。
休克期间尿道NADH增加，复苏期间恢复，而TBF表现出相反的效果（r(2)=0.74）。休克期间骨骼肌和膀胱pO2降低（p<0.01），复苏后恢复。休克期间NADH显著增加（p<0.05），复苏后降低。
尿道黏膜中TBF和NADH的变化代表了组织能量状态的新标志物。它们可以通过微创方法在体内测量，因此可以提供有关失血性休克复苏终点的重要信息。
