Sakio H, Tanaka Y, Ueno K, Oishi S, Ohtsu S, Okuda C
Second Department of Anesthesiology, Dokkyo University School of Medicine, Tochigi.
Masui. 1995 Feb;44(2):227-32.
It is important to repair or ameliorate the intestinal ischemia in critically ill patients. Recent study of our suggests the superiority of dobutamine, but not dopamine, in improving the intestinal oxygenation. In this study we examined the effects of pentoxifylline (PF), glucagon (GL) and prostaglandin E1 (PGE1) during reduced blood flow of the superior mesenteric artery (SMA) in 20 anesthetized dogs. As an index of the intestinal oxygenation, tonometrically measured intestinal intramural pH (pHi) was used. A tonometer was inserted into the midjejunum through enterotomy. The SMA blood flow was measured by a transit-time flow meter. A vascular screw clamp for blood flow reduction was placed around the origin of the SMA, proximal to the flow probe. The SMA blood flow was adjusted to 70% of baseline for three hours. After two hours of decreased blood flow, pHi dropped significantly from baseline. Then, either PF (20 mg.kg-1.min-1 over 10 min, followed by 0.1 mg.kg-1.min-1), GL (1 microgram.kg-1.min-1) or PGE1 (0.05 and 0.5 microgram.kg-1.min-1) was infused intravenously for one hour. With infusions of GL and large dose of PGE1, pHi tended to decrease further, although GL increased the cardiac output. Small dose of PGE1 had no significant effect on pHi. PF treatment showed beneficial effects not only on the cardiac output and the SMA blood flow, but also on pHi. We conclude that PF therapy may restore the intestinal microvascular blood flow. Further study of the effects of PF on tissue oxygenation and blood rheology is warranted.
修复或改善重症患者的肠道缺血状况至关重要。我们最近的研究表明，在改善肠道氧合方面，多巴酚丁胺优于多巴胺。在本研究中，我们检测了己酮可可碱（PF）、胰高血糖素（GL）和前列腺素E1（PGE1）对20只麻醉犬肠系膜上动脉（SMA）血流减少时的影响。采用张力测定法测量的肠道壁内pH值（pHi）作为肠道氧合指标。通过肠切开术将张力测定仪插入空肠中部。用渡越时间流量计测量SMA血流。在靠近血流探头的SMA起始部周围放置一个用于减少血流的血管螺旋夹。将SMA血流调整至基线的70%并持续3小时。血流减少2小时后，pHi从基线显著下降。然后，静脉输注PF（10分钟内20mg·kg-1·min-1，随后0.1mg·kg-1·min-1）、GL（1μg·kg-1·min-1）或PGE1（0.05和0.5μg·kg-1·min-1）1小时。尽管GL增加了心输出量，但输注GL和大剂量PGE1时，pHi仍有进一步下降的趋势。小剂量PGE1对pHi无显著影响。PF治疗不仅对心输出量和SMA血流有有益作用，对pHi也有作用。我们得出结论，PF治疗可能恢复肠道微血管血流。有必要进一步研究PF对组织氧合和血液流变学的影响。
