Desai V S, Weil M H, Tang W, Gazmuri R, Bisera J
Institute of Critical Care Medicine, Palm Springs, CA 92262-5309, USA.
J Lab Clin Med. 1995 Apr;125(4):456-61.
Earlier observations had indicated profound increases in the carbon dioxide tension of the myocardium, gastric wall, liver parenchyma, and renal cortex in the setting of extreme low-flow states of cardiac arrest and resuscitation, hemorrhagic shock, and anaphylactic shock. In venous blood draining the intestines, kidneys, and pelvic viscera, significant increases in PCO2 have also been observed during septic shock. In the present study, we investigated hepatic, renal, and cerebral cortical tissue carbon dioxide tension during intra-abdominal sepsis and shock in Sprague-Dawley rats. Peritonitis was induced by cecal ligation and fecal spillage. Over an interval of 320 +/- 60 minutes, we measured progressive reduction in mean aortic pressure from 152 +/- 11 mm Hg to 25 +/- 8 mm Hg and a decline in cardiac index from 492 +/- 75 ml/kg/min to 169 +/- 57 ml/kg/min. These hemodynamic deficits were accompanied by increases in liver tissue PCO2, from 58 +/- 4 mm Hg to 110 +/- 27 mm Hg (p = 0.006), in renal tissue PCO2, from 38 +/- 7 mm Hg to 115 +/- 24 mm Hg (p < 0.001), and in cerebral cortical tissue CO2, from 59 +/- 6 mm Hg to 108 +/- 16 mm Hg (p = 0.001). Arterial blood lactate content increased from 0.8 to 5.26 +/- 0.2 mmol/L (p = 0.001). Increases in blood lactate content preceded the changes in tissue PCO2 in each of these organs. These studies demonstrate that tissue hypercarbia is a more general phenomenon of low flow states, including that of circulatory shock associated with septic peritonitis.
早期观察表明，在心脏骤停与复苏、失血性休克及过敏性休克等极低流量状态下，心肌、胃壁、肝实质及肾皮质的二氧化碳张力会显著升高。在感染性休克期间，于引流肠道、肾脏及盆腔脏器的静脉血中，也观察到PCO₂显著升高。在本研究中，我们调查了Sprague-Dawley大鼠腹腔内脓毒症和休克期间肝脏、肾脏及大脑皮质组织的二氧化碳张力。通过盲肠结扎和粪便外溢诱导腹膜炎。在320±60分钟的时间段内，我们测量到平均主动脉压从152±11 mmHg逐渐降至25±8 mmHg，心脏指数从492±75 ml/kg/min降至169±57 ml/kg/min。这些血流动力学缺陷伴随着肝组织PCO₂从58±4 mmHg升高至110±27 mmHg（p = 0.006），肾组织PCO₂从38±7 mmHg升高至115±24 mmHg（p < 0.001），以及大脑皮质组织CO₂从59±6 mmHg升高至108±16 mmHg（p = 0.001）。动脉血乳酸含量从0.8 mmol/L增至5.26±0.2 mmol/L（p = 0.001）。在这些器官中，血乳酸含量的升高先于组织PCO₂的变化。这些研究表明，组织高碳酸血症是低流量状态下更普遍的现象，包括与感染性腹膜炎相关的循环性休克。
