Kerner T, Vollmar B, Menger M D, Waldner H, Messmer K
Institute for Surgical Research, Klinikum Innenstadt, Ludwig-Maximilians University, Munich, Germany.
J Surg Res. 1996 May;62(2):165-71. doi: 10.1006/jsre.1996.0190.
The aim of the study was to evaluate the effects of arterial hypotension, high-volume crystalloid resuscitation, and isovolemic hemodilution on pancreatic microvascular perfusion during acute pancreatitis. Using intravital microscopy, pancreatic functional capillary density was analyzed in rats 1 and 2 hr after onset of acute pancreatitis. Pancreatic microvascular perfusion in acute pancreatitis was characterized by a (-62%) significant reduction of functional capillary density predominantly in perinecrotic but also in nonnecrotic tissue (-43%). Pancreatic microvascular perfusion failure was aggravated by arterial hypotension but attenuated by treatment with high-volume crystalloid resuscitation. Isovolemic hemodilution was found superior to high-volume crystalloid resuscitation in maintaining pancreatic functional capillary density and therefore has the best potential in preserving tissue integrity and thereby limiting progression of disease. This study underlines the importance of early fluid resuscitation/hemodilution in patients presenting with acute pancreatitis.
本研究的目的是评估动脉低血压、大量晶体液复苏和等容血液稀释对急性胰腺炎期间胰腺微血管灌注的影响。利用活体显微镜，在急性胰腺炎发作后1小时和2小时对大鼠的胰腺功能性毛细血管密度进行分析。急性胰腺炎时胰腺微血管灌注的特征是功能性毛细血管密度显著降低（-62%），主要发生在坏死周围组织，但非坏死组织中也有降低（-43%）。动脉低血压会加重胰腺微血管灌注衰竭，但大量晶体液复苏治疗可使其减轻。发现在维持胰腺功能性毛细血管密度方面，等容血液稀释优于大量晶体液复苏，因此在保持组织完整性及限制疾病进展方面具有最佳潜力。本研究强调了急性胰腺炎患者早期液体复苏/血液稀释的重要性。
