精氨酸加压素对感染性休克兔胃肠灌注的影响  

Effects of arginine vasopressin on the splanchnic perfusion in rabbit model of septic shock

作　　者：曾健生[1] 申昆玲[2] 钱素云[1] 武志远[1] 樊寻梅[1] 

机构地区：[1]首都医科大学附属北京儿童医院急救中心,北京100045 [2]首都医科大学附属北京儿童医院呼吸科,北京100045

出　　处：《中华急诊医学杂志》2007年第4期390-393,共4页Chinese Journal of Emergency Medicine

基　　金：北京市自然科学基金资助项目（7052027）.

摘　　要：目的评价精氨酸加压素（arginine vasopressin，AVP）对感染性休克兔胃黏膜二氧化碳分压与动脉血二氧化碳分压差（P（g-a）CO2）及肠系膜上动脉血流量的影响。方法日本大白兔麻醉后压力控制通气，静脉注入内毒素复制感染性休克模型，达到休克标准后随机分成2组：单纯补液组（对照组）和精氨酸加压素组（AVP组）。对照组按20ml／（kg·h）输注生理盐水，AVP组除按20ml／（kg·h）输注生理盐水外，持续输注AVP0．001 IU／（kg·min）。连续监测平均动脉压、心率、心脏指数和肠系膜上动脉血流指数，每10min测定胃黏膜二氧化碳分压一次，每小时测定血红蛋白浓度、动静脉血气分析、动脉血乳酸。结果静脉注射内毒素后，两组平均动脉压、心脏指数及肠系膜血流量指数均明显下降，但P（g-a）CO2和乳酸明显增加。分组治疗2h后，两组平均动脉压、心脏指数及肠系膜上动脉血流流指数均上升，除AVP组平均动脉压升高较对照组明显[（72±4）mmHg vs（65±3）mmHg，t=3．7，P〈0．01）外，心脏指数[（181±11）ml／kg vs （187±5）ml／kg，t=1．5，P〉0．05]及肠系膜上动脉血流指数[（14．5±1．9）ml／kg vs （16．1±1．4）ml／kg，t=1．9，P〉0．05）]的变化两组差异无统计学意义。AVP组的P（g-a）CO2较对照组高，但差异亦无显著性统计学意义[（30±3）mmHg vs （27±4）mmHg，t=1．3，P〉0．05）]。结论实验结果显示，感染性休克兔进行容量复苏时，加用小剂量精氨酸加压素有利于恢复平均动脉压，对P（g-a）CO2及肠系膜上动脉血流量无显著影响。Objective Arginine vasopressin （AYP） is increasingly used for the treatment of septic patients with hypotension. However, the effects of AVP on regional blood flow within the splanehnie area during septic shock are poorly determined. This study was designed to assess the effects of AVP on the difference between gastric mucosal and arterial PCO2 （P（g-a） CO2 ） and superior mesenteric blood flow in septic shock. Methods Anesthetized and mechanically ventilated rabbit were subjected to intravenous injection of Lipopolysaccharides from Escherichia coli （2 mg/kg）. Afterwards, animals were randomly assigned to two groups named volume resuscitation （control, n = 8） and arginine vasopressin （AVP group, n = 8）. The rabbits of control group were resuscitated with normal saline solution [20 ml/（kg·h）]. The rabbits of AVP group were infused AVP [0.001 IU/ （kg·min）]in addition to volume resuscitation. Mean arterial pressure and heart rate were continuously recorded . Cardiac index and superior mesenteric blood flow index were continuously monitored by Doppler flowmeter. Gastric mucosal PCO2 was evaluated by gas tonometry every 10 min. Arterial and venous blood gas analyses, hemoglobin, and lactate levels were measured every 1 hour. Results Lipopelysaccharides infusion significantly decreased mean arterial pressure, cardiac output index, and mesenteric blood flow, and meamwhile it increased P（g-a）CO2 and arterial lactate in both groups. After treatment for 2 hs, mean arterial pressure, cardiac output index, and mesenteric blood flow index increased in both groups. The AVP group exhibited significantly higher mean arterial pressure as compared with control group [ （72 ± 4） mmHg vs （65 ± 3） mmHg, t = 3.7, P 〈 0.01 ]. There were no significant differences between two groups in cardiac index [ （181 ± 11 ） ml/kg vs （187 ± 5） ml/kg, t = 1. 5, P 〉 0.05）, and mesenterie blood flow index [ （14.5 ± 1.9） ml/kg vs （16.1 ± 1.4） ml/ kg, t = 1.9, P 〉 0.05]. The AVP gr

关 键 词：感染性休克 精氨酸加压素 胃黏膜二氧化碳分压 

分 类 号：R686[医药卫生—骨科学]