Rackow E C, Mecher C, Astiz M E, Goldstein C, McKee D, Weil M H
Department of Medicine, University of Health Sciences, Chicago Medical School, IL 60064.
Circ Shock. 1990 Feb;30(2):107-15.
It is assumed that the development of metabolic acidosis during sepsis is secondary to lactic acidosis. We assessed the composition of the anion gap during severe sepsis induced by cecal perforation in rats. In the first experiment, cardiac output, arterial blood gases, and arterial lactate were measured over a 6 hr interval in five septic rats and in five rats serving as sham-operated controls. The cardiac output decreased from 331 +/- 32 to 172 +/- 9 ml/kg/min (P less than 0.01) in the septic rats. Although the arterial lactate was increased to 2.1 +/- 0.2 mEq/L in septic rats compared to 0.8 +/- 0.1 mEq/L in sham rats (P less than 0.01), the HCO3- was decreased to 16.5 +/- 0.6 mEq/L in septic rats versus 23.8 +/- 1.10 mEq/L in sham rats (P less than 0.01). We further investigated this bicarbonate deficit in a second study in which arterial blood was sampled at 6 hr for blood gases, and plasma Na+, K+, Cl-, HCO3-, lactate, pyruvate, beta-hydroxybutyrate, acetoacetate, citrate, creatinine, albumin, and amino acids in five septic and five sham rats. The serum anion gap was calculated as [(Na(+) + K+) - (Cl(-) + HCO3-)]. The anion gap was 21.6 +/- 1.6 mEq/L in the septic animals as compared to 13.2 +/- 0.5 mEq/L in the sham animals (P less than 0.01). There were no differences in the concentration of pyruvate, beta-hydroxybutyrate, acetoacetate, citrate, creatinine, albumin, or amino acids.(ABSTRACT TRUNCATED AT 250 WORDS)
一般认为，脓毒症期间代谢性酸中毒的发生继发于乳酸酸中毒。我们评估了大鼠盲肠穿孔诱导的严重脓毒症期间阴离子间隙的组成。在第一个实验中，在6小时内测量了5只脓毒症大鼠和5只假手术对照大鼠的心输出量、动脉血气和动脉乳酸水平。脓毒症大鼠的心输出量从331±32降至172±9 ml/kg/min（P<0.01）。虽然脓毒症大鼠的动脉乳酸水平升至2.1±0.2 mEq/L，而假手术大鼠为0.8±0.1 mEq/L（P<0.01），但脓毒症大鼠的HCO3-降至16.5±0.6 mEq/L，假手术大鼠为23.8±1.10 mEq/L（P<0.01）。在第二项研究中，我们进一步研究了这种碳酸氢盐缺乏情况，在该研究中，对5只脓毒症大鼠和5只假手术大鼠在6小时时采集动脉血进行血气分析，并检测血浆Na+、K+、Cl-、HCO3-、乳酸、丙酮酸、β-羟丁酸、乙酰乙酸、柠檬酸、肌酐、白蛋白和氨基酸。血清阴离子间隙计算公式为[(Na(+) + K+) - (Cl(-) + HCO3-)]。脓毒症动物的阴离子间隙为21.6±1.6 mEq/L，假手术动物为13.2±0.5 mEq/L（P<0.01）。丙酮酸、β-羟丁酸、乙酰乙酸、柠檬酸、肌酐、白蛋白或氨基酸的浓度没有差异。（摘要截短于250字）
