Zhang H, Vincent J L
Department of Intensive Care, Erasme University Hospital, Free University of Brussels, Belgium.
Circ Shock. 1993 Jul;40(3):168-76.
The present study used a model of cardiac tamponade to investigate the effects of endotoxin on the oxygen extraction capabilities of the body during an acute reduction in blood flow, when blood volume and arterial oxygen content were maintained. In 21 pentobarbital anesthetized, mechanically ventilated dogs, two catheters were introduced into the pericardial space to induce cardiac tamponade, and simultaneously to measure the intrapericardial pressure. Oxygen uptake (VO2) was determined from the expired gases. Oxygen delivery (DO2) was calculated by the product of the thermodilution cardiac index and the arterial oxygen content. Eleven dogs received 2 mg/kg Escherichia coli endotoxin, followed by generous saline infusion (20 ml/kg.hr). Ten dogs served as a control group. In each dog, DO2 was progressively reduced by pericardial saline infusion at a rate of 40 ml/hr for the first hour and 30 ml/hr thereafter. Critical O2 delivery (DO2crit) and critical O2 extraction ratio (O2ERcrit) were determined from a plot of VO2/DO2 for each individual dog. The DO2crit was greater in the endotoxic than in the control group (12.1 +/- 3.1 ml/kg.min vs. 9.6 +/- 1.6 ml/kg.min; P < 0.05). Endotoxin at the dose used did not alter VO2 (or critical VO2). Accordingly, O2ERcrit was significantly lower in the endotoxic than in the control animals (47.2% +/- 5.7% vs. 60.3% +/- 10.6%; P < 0.01). The mixed venous PO2 levels at DO2crit were higher in the endotoxic than in the control group (30.6 +/- 6.1 mm Hg vs. 25.4 +/- 5.2 mm Hg; P < 0.05). Arterial blood lactate concentration was higher in the endotoxic than in the control dogs.(ABSTRACT TRUNCATED AT 250 WORDS)
本研究采用心脏压塞模型,在维持血容量和动脉血氧含量的情况下,研究急性血流减少期间内毒素对机体氧摄取能力的影响。在21只戊巴比妥麻醉、机械通气的犬中,插入两根导管至心包腔以诱导心脏压塞,并同时测量心包内压力。通过呼出气体测定氧摄取量(VO2)。氧输送量(DO2)通过热稀释心指数与动脉血氧含量的乘积计算得出。11只犬接受2mg/kg大肠杆菌内毒素,随后大量输注生理盐水(20ml/kg·小时)。10只犬作为对照组。在每只犬中,通过心包内输注生理盐水,使DO2以每小时40ml的速率逐渐降低,第一小时后为每小时30ml。根据每只犬的VO2/DO2曲线确定临界氧输送量(DO2crit)和临界氧摄取率(O2ERcrit)。内毒素组的DO2crit高于对照组(12.1±3.1ml/kg·分钟对9.6±1.6ml/kg·分钟;P<0.05)。所用剂量的内毒素未改变VO2(或临界VO2)。因此,内毒素组的O2ERcrit显著低于对照组动物(47.2%±±5.7%对60.3%±10.6%;P<0.01)。DO2crit时内毒素组的混合静脉血氧分压水平高于对照组(30.6±6.1mmHg对25.4±5.2mmHg;P<0.05)。内毒素组犬的动脉血乳酸浓度高于对照组。(摘要截短至250字)