Ellsworth M L, Goldfarb R D, Alexander R S, Bell D R, Powers S R
Adv Shock Res. 1981;5:89-99.
Impaired peripheral oxygen utilization coinciding with an elevated cardiac index, venous oxygen tension, and serum lactate with the loss of reactive hyperemic response have been observed in a large series of resuscitated trauma patients. We tested the hypothesis that these clinical findings were due to an alteration of the microcirculation caused by embolization of intravascular particulate matter. To test this hypothesis, we used the bilateral pump-perfused, isolated canine gracilis muscle preparation which we subjected to microembolization with 15 micrometers polystyrene spheres. Prior to microembolization, oxygen consumption was flow-limited up to 6 ml min-1 (r = .928) and at higher flows, oxygen consumption was independent of flow. Following microembolization, the relationship of oxygen consumption and blood flow remained correlated (r = .893), but there was less oxygen consumption at any given flow rate (P less than .05). Imidazole, 30 mg kg-1, IP administered to prevent platelet aggregation, resulted in the return of oxygen utilization to the preembolization value. PVO2 of the microembolized muscle was significantly higher than in the contralateral muscle, which was abolished after imidazole administration. These data suggest that microembolization leads to an oxygen utilization defect similar to that observed in the resuscitated trauma patient. Since this defect was reversed by imidazole administration, a humoral mechanism in the microcirculatory bed may act to restrict oxygen utilization following microembolization and trauma.
在大量复苏后的创伤患者中,观察到外周氧利用受损,同时伴有心脏指数升高、静脉血氧张力升高、血清乳酸升高以及反应性充血反应丧失。我们检验了这样一个假设,即这些临床发现是由于血管内颗粒物栓塞导致微循环改变所致。为了验证这一假设,我们使用了双侧泵灌注的离体犬股薄肌制备物,并对其进行15微米聚苯乙烯微球栓塞。在微栓塞之前,耗氧量在血流量达到6毫升/分钟之前受流量限制(r = 0.928),而在更高流量时,耗氧量与流量无关。微栓塞后,耗氧量与血流量之间的关系仍然相关(r = 0.893),但在任何给定流量下耗氧量都减少了(P < 0.05)。腹腔注射30毫克/千克咪唑以防止血小板聚集,可使氧利用恢复到栓塞前的值。微栓塞肌肉的静脉血氧分压显著高于对侧肌肉,注射咪唑后这种差异消失。这些数据表明,微栓塞导致的氧利用缺陷与复苏后的创伤患者中观察到的相似。由于这种缺陷可通过注射咪唑得到逆转,微循环床中的一种体液机制可能在微栓塞和创伤后限制氧利用。