Secchi A, Wellmann R, Martin E, Schmidt H
Department of Anaesthesia, University of Heidelberg, Germany.
J Crit Care. 1997 Sep;12(3):137-41. doi: 10.1016/s0883-9441(97)90043-5.
The gut plays a pivotal role in sepsis. Intestinal hypoperfusion with subsequent ischemia leads to translocation of endotoxin. Dobutamine has been demonstrated to increase mesenteric blood flow during endotoxic shock; however, its effects on mucosal blood flow especially in intestinal villi is not known. Therefore, we investigated its influence on the blood flow and the arteriolar diameters in intestinal villi in a model of normotensive endotoxemia.
Twenty-one male Wistar rats were divided into three groups: (1) control, saline; (2) endotoxin, endotoxin 1.5 mg/kg during 60 minutes; and (3) dobutamine, endotoxin 1.5 mg/kg (60 minutes) and dobutamine 2.5 micrograms/kg/min during 120 minutes. Villus blood flow and arteriolar diameters were determined at 0 minutes, 60 minutes, and 120 minutes in each group using intravital microscopy.
Villus blood flow was constant in the control group, significantly reduced at 120 minutes in the endotoxin group (120 minutes, 55.1 +/- 7.4%), and remained at baseline values in the dobutamine group. The arteriolar diameters remained constant in the control and the dobutamine groups, but they were significantly reduced in the endotoxin group at 120 minutes (7.8 +/- 0.2 to 6.5 +/- 0.7 micron).
Our results indicate that in rats with normotensive endotoxemia, arteriolar diameters and blood flow in intestinal villi were reduced. Dobutamine prevented arteriolar constriction and maintained villus blood flow at preendotoxemic values.
肠道在脓毒症中起关键作用。肠道灌注不足及随后的缺血会导致内毒素移位。已证实多巴酚丁胺可在内毒素休克期间增加肠系膜血流;然而,其对黏膜血流尤其是肠绒毛血流的影响尚不清楚。因此,我们在正常血压内毒素血症模型中研究了其对肠绒毛血流和小动脉直径的影响。
21只雄性Wistar大鼠分为三组:(1)对照组,给予生理盐水;(2)内毒素组,60分钟内给予内毒素1.5mg/kg;(3)多巴酚丁胺组,60分钟内给予内毒素1.5mg/kg,随后120分钟给予多巴酚丁胺2.5μg/kg/min。每组分别在0分钟、60分钟和120分钟使用活体显微镜测定绒毛血流和小动脉直径。
对照组绒毛血流保持恒定,内毒素组在120分钟时显著降低(120分钟时,55.1±7.4%),多巴酚丁胺组则维持在基线值。对照组和多巴酚丁胺组小动脉直径保持恒定,但内毒素组在120分钟时显著减小(从7.8±0.2微米降至6.5±0.7微米)。
我们的结果表明,在正常血压内毒素血症大鼠中,肠绒毛小动脉直径和血流减少。多巴酚丁胺可防止小动脉收缩,并将绒毛血流维持在内毒素血症前的值。