Kohler J P, Rice C L, Zarins C K, Cammack B F, Moss G S
Crit Care Med. 1981 Feb;9(2):90-3. doi: 10.1097/00003246-198102000-00004.
Starling's hypothesis of forces governing fluid movement across capillary membranes suggests that any unopposed decrease in intracapillary colloid oncotic pressure (COP) or increase in capillary permeability should result in increased interstitial fluid. Iso-oncotic increase in pulmonary artery wedge (PAW) causes pulmonary dysfunction. Isobaric reduction of COP with normal capillary permeability does not result in pulmonary interstitial edema. Because sepsis is a frequent antecedent of clinical pulmonary dysfunction, the question was asked: does reduction in the COP-PAW gradient in the presence of sepsis result in increased pulmonary dysfunction? Twenty baboons were studied: group 1--control, group 2--4-h constant infusion of E. coli, group 3--plasmapheresis alone, group 4--plasmapheresis followed by sepsis. Ringer's lactate was infused to keep PAW constant. Arterial and mixed venous blood gases were drawn and the intrapulmonary shunt (QS/QT) was calculated. The data were compared using Tukey's HSD test and one way analysis of variance. Plasmapheresis alone resulted in a 68% reduction in COP (15 +/- 2.9 (SD) torr to 4.6 +/- 0.6 in group 3 and 16.5 +/- 4.3 to 5.7 +/- 0.9 in group 4, p less than 0.05). Sepsis resulted in an increase in QS/QT in all septic animals. There was no increased QS/QT in those animals that had sepsis added to plasmapheresis, group 4 (p less than 0.05). These data indicate that sepsis leads to pulmonary dysfunction but that this dysfunction appears to be independent of colloid oncotic forces.
斯塔林关于控制液体通过毛细血管膜运动的力的假说表明，毛细血管内胶体渗透压（COP）的任何无对抗性降低或毛细血管通透性增加都应导致间质液增加。肺动脉楔压（PAW）的等渗增加会导致肺功能障碍。在毛细血管通透性正常的情况下，等压降低COP不会导致肺间质水肿。由于脓毒症是临床肺功能障碍的常见前驱因素，因此提出了一个问题：在脓毒症存在的情况下，COP-PAW梯度降低是否会导致肺功能障碍增加？对20只狒狒进行了研究：第1组为对照组，第2组为持续4小时输注大肠杆菌，第3组为单纯血浆置换，第4组为血浆置换后发生脓毒症。输注乳酸林格液以维持PAW恒定。采集动脉血和混合静脉血气体，并计算肺内分流（QS/QT）。使用Tukey's HSD检验和单因素方差分析对数据进行比较。单纯血浆置换导致COP降低68%（第3组从15±2.9（标准差）托降至4.6±0.6，第4组从16.5±4.3降至5.7±0.9，p<0.05）。脓毒症导致所有脓毒症动物的QS/QT增加。在血浆置换后添加脓毒症的动物（第4组）中，QS/QT没有增加（p<0.05）。这些数据表明，脓毒症会导致肺功能障碍，但这种功能障碍似乎与胶体渗透压无关。
