前列环素可降低猫脂多糖诱导性脑膜炎时的颅内压升高及血浆容量丢失。

Prostacyclin reduces elevation of intracranial pressure and plasma volume loss in lipopolysaccharide-induced meningitis in the cat.

作者信息

Jungner Mårten, Bentzer Peter, Grände Per-Olof

机构信息

Department of Anesthesia and Intensive Care, Lund University and Lund University Hospital, Lund, Sweden.

出版信息

J Trauma. 2009 Dec;67(6):1345-51. doi: 10.1097/TA.0b013e3181a5f211.

DOI:10.1097/TA.0b013e3181a5f211

PMID:20009688

Abstract

BACKGROUND

Severe meningitis may compromise cerebral perfusion through increases in intracranial pressure (ICP) and through hypovolemia caused by a general inflammation with systemic plasma leakage. From its antiaggregative/antiadhesive and permeability-reducing properties, prostacyclin (PGI2) is a potential adjuvant treatment in meningitis, but previously published data have been ambiguous. The objective of this study was to evaluate the effects of PGI2 on meningitis on ICP, plasma volume, blood pressure, and cerebral oxidative metabolism.

METHODS

Meningitis was induced by intrathecal injection of lipopolysaccharide (LPS, 0.8 x 10 units/kg) in cats. Four hours after the injection, the animals were randomized to intravenous treatment with either low-dose PGI2 (1 ng/kg/min) or the vehicle for 6 hours (n = 7 in each group). No LPS and no PGI2 or vehicle was given to three cats (sham group). Effects of treatment on ICP, mean arterial pressure, plasma volume (I-albumin technique), and brain tissue lactate/pyruvate ratio (microdialysis technique) were evaluated.

RESULTS

ICP increased from 10.0 mm Hg +/- 1.3 mm Hg and 10.8 mm Hg +/- 1.7 mm Hg to 19.9 mm Hg +/- 1.7 mm Hg and 19.6 mm Hg +/- 3.3 mm Hg in the PGI2 and the vehicle group, respectively, 4 hours after the LPS injection (not significant). ICP increased further to 21.8 mm Hg +/- 4.5 mm Hg and to 25.8 mm Hg +/- 6.0 mm Hg after treatment for 6 hours with PGI2 or vehicle, respectively (p < 0.05). There was no significant difference in arterial pressure between groups. Plasma volume loss was less in the PGI2 group than in the vehicle group at the end of the experiment and urine production and arterial oxygenation was higher in the PGI2 group. Lactate/pyruvate ratio was within the normal range in all groups.

CONCLUSION

Low-dose PGI2 may be a beneficial adjuvant therapy for meningitis by reducing elevation of ICP and plasma volume loss.

摘要

背景

严重脑膜炎可能通过颅内压（ICP）升高以及全身性炎症伴全身血浆渗漏导致的血容量减少来损害脑灌注。鉴于前列环素（PGI2）具有抗聚集/抗黏附及降低通透性的特性，它可能是脑膜炎的一种潜在辅助治疗药物，但此前发表的数据并不明确。本研究的目的是评估PGI2对脑膜炎患者的ICP、血浆容量、血压和脑氧化代谢的影响。

方法

通过向猫鞘内注射脂多糖（LPS，0.8×10单位/千克）诱导脑膜炎。注射4小时后，将动物随机分为两组，分别接受低剂量PGI2（1纳克/千克/分钟）静脉治疗或赋形剂治疗6小时（每组n = 7）。三只猫（假手术组）未给予LPS、PGI2或赋形剂。评估治疗对ICP、平均动脉压、血浆容量（I-白蛋白技术）和脑组织乳酸/丙酮酸比值（微透析技术）的影响。

结果

LPS注射后4小时，PGI2组和赋形剂组的ICP分别从10.0毫米汞柱±1.3毫米汞柱和10.8毫米汞柱±1.7毫米汞柱升至19.9毫米汞柱±1.7毫米汞柱和19.6毫米汞柱±3.3毫米汞柱（无显著差异）。用PGI2或赋形剂治疗6小时后，ICP进一步分别升至21.8毫米汞柱±4.5毫米汞柱和25.8毫米汞柱±6.0毫米汞柱（p < 0.05）。两组间动脉压无显著差异。实验结束时，PGI2组的血浆容量损失低于赋形剂组，且PGI2组的尿量和动脉氧合更高。所有组的乳酸/丙酮酸比值均在正常范围内。