Schmidt J, Hotz H G, Foitzik T, Ryschich E, Buhr H J, Warshaw A L, Herfarth C, Klar E
Department of Surgery, University of Heidelberg, Germany.
Ann Surg. 1995 Mar;221(3):257-64. doi: 10.1097/00000658-199503000-00007.
Previous reports demonstrated that radiographic contrast medium, as used in contrast-enhanced computed tomography, increases acinar necrosis and mortality in experimental pancreatitis. The authors studied the possibility that these changes may be related to an additional impairment of pancreatic microcirculation.
Fifty Wistar rats had acute pancreatitis induced by intraductal glycodeoxycholic acid (10 mmol/L for 10 min) and intravenous cerulein (5 micrograms/kg/hr for 6 hrs). After rehydration (16 mL/kg), pancreatic capillary perfusion was quantified by means of intravital microscopy at baseline before intravenous infusion of contrast medium (n = 25) or saline (n = 25), and 30 and 60 minutes thereafter. In addition to total capillary flow, capillaries were categorized as high- or low-flow (> or < 1.6 nL/min).
Pancreatic capillary flow did not change in either high- or low-flow capillaries after saline infusion. However, contrast medium infusion induced a significant decrease of total capillary flow (p < 0.001). Analysis according to the relative flow rate revealed that this was primarily because of a significant additional reduction of perfusion in low-flow capillaries (p < 0.0001). Furthermore, complete capillary stasis was observed in 15.9 +/- 3.4% after contrast medium as compared with 3.2 +/- 1.2% after saline infusion (p < 0.006).
Radiographic contrast medium aggravates the impairment of pancreatic microcirculation in experimental necrotizing pancreatitis.
既往报告显示，用于增强计算机断层扫描的放射造影剂会增加实验性胰腺炎中的腺泡坏死和死亡率。作者研究了这些变化可能与胰腺微循环的额外损害有关的可能性。
50只Wistar大鼠通过导管内注入甘氨脱氧胆酸（10 mmol/L，持续10分钟）和静脉注射雨蛙肽（5微克/千克/小时，持续6小时）诱导急性胰腺炎。补液（16毫升/千克）后，在静脉输注造影剂（n = 25）或生理盐水（n = 25）前的基线水平，以及之后30分钟和60分钟，通过活体显微镜对胰腺毛细血管灌注进行定量。除了总毛细血管流量外，毛细血管被分为高流量或低流量（>或<1.6纳升/分钟）。
输注生理盐水后，高流量或低流量毛细血管中的胰腺毛细血管流量均未改变。然而，输注造影剂导致总毛细血管流量显著下降（p < 0.001）。根据相对流速进行分析显示，这主要是由于低流量毛细血管中的灌注显著进一步减少（p < 0.0001）。此外，输注造影剂后观察到15.9 +/- 3.4%的毛细血管完全停滞，而输注生理盐水后为3.2 +/- 1.2%（p < 0.006）。
放射造影剂会加重实验性坏死性胰腺炎中胰腺微循环的损害。
