Beck Christopher, Barthel Franziska, Hahn Anna-Maria, Vollmer Christian, Herminghaus Anna, Schäfer Sabrina, Bauer Inge, Picker Olaf
Department of Anaesthesiology, University Hospital Duesseldorf, Germany.
Department of Anaesthesiology, University Hospital Duesseldorf, Germany.
Microvasc Res. 2015 May;99:78-85. doi: 10.1016/j.mvr.2015.02.009. Epub 2015 Mar 7.
Acute hypercapnia maintains the microcirculatory oxygenation of the splanchnic region during sepsis. The first aim of this study was to characterize the role of K(+)ATP channels on the microcirculatory flow and oxygenation during acute moderate hypercapnia. The second aim was to investigate whether a short period of hypercapnia induces detrimental effects in an otherwise undamaged rodent lung.
Experiments were performed on 60 male Wistar rats. A moderate polymicrobial sepsis was induced by colon ascendens stent peritonitis (CASP) surgery. 24h after induction of sepsis volume-controlled and pressure-limited ventilation was established for 120 min, with either normocapnic (pCO2 35-45 mmHg) or moderate hypercapnic ventilation targets (pCO2 65-75 mmHg) and with or without non-selective K(+)ATP channel blockade with glibenclamide. Microcirculatory blood flow of the colonic wall as well as oxygen delivery and consumption were assessed with tissue laser Doppler and reflectance spectrophotometry. Hemodynamic variables were recorded and plasma cytokine levels and myeloperoxidase levels of the lungs were analyzed.
In septic animals microcirculatory oxygenation deteriorated progressively with normocapnia (-11.7 ± 11.8%) but was maintained (-2.9 ± 5.6%) with hypercapnia. This effect was associated with an increased microcirculatory oxygen consumption in septic animals with normocapnia (+25.7 ± 37.1%) that was decreased in the hypercapnia groups (-7.2 ± 28.1%). The effect of hypercapnia in septic animals was not altered by additional K(+)ATP channel blockade (-5.7 ± 32.7%). Hypercapnia neither induced an inflammatory response in lungs nor altered the systemic cytokine response.
The observed beneficial effect of hypercapnia on microvascular oxygenation of the colon in sepsis does not seem to be mediated via K(+)ATP channels.
急性高碳酸血症可维持脓毒症期间内脏区域的微循环氧合。本研究的首要目的是明确急性中度高碳酸血症期间钾离子ATP通道在微循环血流和氧合中的作用。第二个目的是研究短时间高碳酸血症是否会对原本未受损的啮齿动物肺造成有害影响。
对60只雄性Wistar大鼠进行实验。通过升结肠支架性腹膜炎(CASP)手术诱导中度混合菌血症。在诱导菌血症24小时后,建立容量控制和压力限制通气120分钟,通气目标为正常碳酸血症(pCO2 35 - 45 mmHg)或中度高碳酸血症(pCO2 65 - 75 mmHg),并使用或不使用格列本脲进行非选择性钾离子ATP通道阻断。用组织激光多普勒和反射分光光度法评估结肠壁的微循环血流量以及氧输送和消耗情况。记录血流动力学变量,并分析肺组织的血浆细胞因子水平和髓过氧化物酶水平。
在脓毒症动物中,正常碳酸血症时微循环氧合逐渐恶化(-11.7 ± 11.8%),而高碳酸血症时则得以维持(-2.9 ± 5.6%)。这种效应与正常碳酸血症的脓毒症动物微循环氧消耗增加(+25.7 ± 37.1%)有关,而在高碳酸血症组中氧消耗减少(-7.2 ± 28.1%)。高碳酸血症对脓毒症动物的影响不会因额外的钾离子ATP通道阻断而改变(-5.7 ± 32.7%)。高碳酸血症既不会在肺中诱导炎症反应,也不会改变全身细胞因子反应。
高碳酸血症对脓毒症结肠微血管氧合的有益作用似乎并非通过钾离子ATP通道介导。