Morisaki H, Bloos F, Keys J, Martin C, Neal A, Sibbald W J
A. C. Burton Vascular Biology Laboratory, Victoria Hospital Research Institute, London, Ontario, Canada.
J Appl Physiol (1985). 1994 Sep;77(3):1507-18. doi: 10.1152/jappl.1994.77.3.1507.
We tested the hypothesis that the type of fluid infused to chronically maintain intravascular volumes would modify both microvascular integrity and cellular structure in extrapulmonary organs in hyperdynamic sepsis. After cecal ligation and perforation, awake sheep were treated for 48 h with 10% pentastarch (n = 9), 10% pentafraction (Du Pont Critical Care; n = 8), or Ringer lactate (n = 8) titrated to maintain a constant left atrial pressure. After 48 h of fluid therapy, biopsy samples were taken from the left ventricle and gastrocnemius for electron microscopy. At this time, all groups demonstrated a similar hyperdynamic circulatory response, increased systemic O2 utilization and organ blood flows, measured by radioactive microsphere injection. However, greater capillary luminal areas with less endothelial swelling and less parenchymal injury were found in septic sheep treated with pentastarch vs. Ringer lactate infusion in both muscle types. Pentafraction showed few benefits in study end points over pentastarch. Thus, we conclude that chronic intravascular volume resuscitation of hyperdynamic sepsis with pentastarch ameliorated the progression of both microvascular and parenchymal injury. These findings indicate that microvascular surface area for tissue O2 exchange in sepsis may be better preserved with chronically infused colloid, resulting in less parenchymal injury.
在高动力型脓毒症中，用于长期维持血管内容量的输液类型会改变肺外器官的微血管完整性和细胞结构。在进行盲肠结扎和穿孔后，对清醒的绵羊进行48小时的治疗，分别给予10%的羟乙基淀粉（n = 9）、10%的Pentafraction（杜邦重症护理；n = 8）或乳酸林格液（n = 8），通过滴定以维持恒定的左心房压力。在进行48小时的液体治疗后，从左心室和腓肠肌采集活检样本用于电子显微镜检查。此时，通过放射性微球注射测量发现，所有组均表现出相似的高动力循环反应、全身氧利用率增加和器官血流增加。然而，与输注乳酸林格液的脓毒症绵羊相比，输注羟乙基淀粉的脓毒症绵羊在两种肌肉类型中均发现有更大的毛细血管腔面积、更少的内皮肿胀和更少的实质损伤。Pentafraction在研究终点方面相较于羟乙基淀粉几乎没有优势。因此，我们得出结论，用羟乙基淀粉对高动力型脓毒症进行慢性血管内容量复苏可改善微血管和实质损伤的进展。这些发现表明，脓毒症中用于组织氧交换的微血管表面积可能通过长期输注胶体得到更好的保留，从而减少实质损伤。
