Pranskunas Andrius, Pilvinis Vidas, Dambrauskas Zilvinas, Rasimaviciute Renata, Planciuniene Rita, Dobozinskas Paulius, Veikutis Vincentas, Vaitkaitis Dinas, Boerma E Christiaan
Crit Care. 2012 May 15;16(3):R83. doi: 10.1186/cc11341.
The aim of the study was to evaluate and compare the microcirculatory perfusion during experimental sepsis in different potentially available parts of the body, such as sublingual mucosa, conjunctiva of the eye, and mucosa of jejunum and rectum.
Pigs were randomly assigned to sepsis (n = 9) and sham (n = 4) groups. The sepsis group received a fixed dose of live Escherichia coli infusion over a 1-hour period (1.8 × 10(9)/kg colony-forming units). Animals were observed 5 hours after the start of E. coli infusion. In addition to systemic hemodynamic assessment, we performed conjunctival, sublingual, jejunal, and rectal evaluation of microcirculation by using Sidestream Dark Field (SDF) videomicroscopy at the same time points: at baseline, and at 3 and 5 hours after the start of live E. coli infusion. Assessment of microcirculatory parameters of convective oxygen transport (microvascular flow index (MFI) and proportion of perfused vessels (PPV)), and diffusion distance (perfused vessel density (PVD) and total vessel density (TVD)) was done by using a semiquantitative method.
Infusion of E. coli resulted in a hypodynamic state of sepsis associated with low cardiac output and increased systemic vascular resistance despite fluid administration. Significant decreases in MFI and PPV of small vessels were observed in sublingual, conjunctival, jejunal, and rectal locations 3 and 5 hours after the start of E. coli infusion in comparison with baseline variables. Correlation between sublingual and conjunctival (r = 0.80; P = 0.036), sublingual and jejunal (r = 0.80; P = 0.044), and sublingual and rectal (r = 0.79; P = 0.03) MFI was observed 3 hours after onset of sepsis. However, this strong correlation between the sublingual and other regions disappeared 5 hours after the start of E. coli infusion. Overall, the sublingual mucosa exhibited the most-pronounced alterations of microcirculatory flow in comparison with conjunctival, jejunal, and rectal microvasculature (P < 0.05).
In this pig model, a time-dependent correlation exists between sublingual and microvascular beds during the course of a hypodynamic state of sepsis.
本研究的目的是评估和比较在实验性脓毒症期间身体不同潜在可用部位（如舌下黏膜、眼结膜、空肠黏膜和直肠黏膜）的微循环灌注情况。
将猪随机分为脓毒症组（n = 9）和假手术组（n = 4）。脓毒症组在1小时内接受固定剂量的活大肠杆菌输注（1.8×10⁹/千克菌落形成单位）。在大肠杆菌输注开始后5小时观察动物。除了进行全身血流动力学评估外，我们在相同时间点（基线、活大肠杆菌输注开始后3小时和5小时）使用侧流暗视野（SDF）视频显微镜对结膜、舌下、空肠和直肠的微循环进行评估。通过半定量方法评估对流氧输送的微循环参数（微血管血流指数（MFI）和灌注血管比例（PPV））以及扩散距离（灌注血管密度（PVD）和总血管密度（TVD））。
输注大肠杆菌导致脓毒症的低动力状态，尽管进行了液体输注，但心输出量降低且全身血管阻力增加。与基线变量相比，在大肠杆菌输注开始后3小时和5小时，舌下、结膜、空肠和直肠部位的小血管MFI和PPV显著降低。脓毒症发作后3小时观察到舌下与结膜（r = 0.80；P = 0.036）、舌下与空肠（r = 0.80；P = 0.044）以及舌下与直肠（r = 0.79；P = 0.03）MFI之间存在相关性。然而，在大肠杆菌输注开始后5小时，舌下与其他区域之间的这种强相关性消失。总体而言，与结膜、空肠和直肠微血管相比，舌下黏膜的微循环血流改变最为明显（P < 0.05）。
在该猪模型中，脓毒症低动力状态过程中舌下与微血管床之间存在时间依赖性相关性。
