Jamieson W G, Taylor B M, Troster M, Durand D
Surg Gynecol Obstet. 1979 Mar;148(3):334-8.
This study has confirmed previous experiments which indicated that inorganic phosphate concentrations rise in body fluids after intestinal infarction. The phosphate clearance ratio is elevated in dogs after occlusion of the superior mesenteric artery, but is not as sensitive as indicator of the presence of a necrotic intestine as the serum or peritoneal fluid phosphate levels. The rise and fall of phosphate levels occur within the first 24 hours after infarction, similar to amylase levels in acute pancreatitis. The renal failure observed in dogs after ligation of the superior mesenteric vein is likely on the basis of hypovolemia and does not seem to result from hyperphosphatemia. Intestinal infarction should be suspected with laboratory evidence of hemo-concentration, marked leukocytosis, an inappropriate metabolic acidosis and elevated serum and peritoneal fluid phosphate levels. In dogs with normal renal function, an elevated urinary phosphate clearance ratio of greater than 0.20, as measured on a spot sample of urine and serum, is also highly suggestive of the presence of this condition, but its absence, by no means, excludes the diagnosis. With these simple laboratory tests, possibly an earlier diagnosis can be made, and timely operation can be an entirely intestine-saving procedure.
本研究证实了先前的实验，这些实验表明肠道梗死后体液中的无机磷酸盐浓度会升高。肠系膜上动脉闭塞后，犬的磷酸盐清除率升高，但作为坏死肠管存在的指标，其不如血清或腹腔液中的磷酸盐水平敏感。磷酸盐水平的升高和下降发生在梗死后的最初24小时内，类似于急性胰腺炎时淀粉酶水平的变化。肠系膜上静脉结扎后犬出现的肾衰竭可能是基于血容量不足，似乎并非由高磷血症引起。当有血液浓缩、明显白细胞增多、不适当的代谢性酸中毒以及血清和腹腔液磷酸盐水平升高的实验室证据时，应怀疑肠道梗死。在肾功能正常的犬中，通过即时尿样和血清检测，尿磷酸盐清除率大于0.20的升高也高度提示存在这种情况，但其不存在绝不能排除诊断。通过这些简单的实验室检查，可能可以做出更早的诊断，及时手术可能是完全挽救肠管的手术。
