休克再灌注期间肠粘膜pH及肠粘膜与动脉血二氧化碳分压差的变化  

Changes in colonic intramucosal pH and PCO_2 gradient between colonic mucosa and arterial blood during hemorrhagic shock and reperfusion in rabbits

作　　者：夏中元[1] 胡岚[1] 郑利民[1] 

机构地区：[1]湖北医科大学附属第一医院麻醉科,湖北武汉430060

出　　处：《中国危重病急救医学》2000年第2期96-98,共3页Chinese Critical Care Medicine

摘　　要：目的：探讨低血容量性休克及再灌注时肠粘膜ｐＨ（ｐＨｉ）及肠粘膜与动脉血二氧化碳分压（ＰＣＯ２ ）差（Ｐｉ－ ａＣＯ２ ）的变化及意义。方法：采用兔低血容量性休克及再灌注模型，通过Ｔｏｎｏｍ ｅｔｒｙ 张力计测定并计算休克前（Ｓ０ ）、休克１ 小时（Ｓ１）及再灌注１ 小时（ＲＥＰ１ ）、２ 小时（ＲＥＰ２ ）乙状结肠ｐＨｉ及Ｐｉ－ ａＣＯ２ ，同时监测血流动力学及氧指标，并依据ｃｈｉｕ 法观察ＲＥＰ２ 时肠粘膜病理改变分级。结果：Ｓ１、ＲＥＰ１ 及ＲＥＰ２ ３个时点乙状结肠ｐＨｉ显著低于对照组和Ｓ０，而Ｐｉ－ ａＣＯ２ 明显高于对照组和Ｓ０ （Ｐ均＜ ０．０１），且ＲＥＰ１ 、ＲＥＰ２ 与Ｓ１ 时ｐＨｉ及Ｐｉ－ ａＣＯ２ 无差异。ＲＥＰ２ 时肠粘膜损伤（肠上皮坏死脱落）为Ⅱ～Ⅲ级并与ｐＨｉ正相关。与乙状结肠ｐＨｉ及Ｐｉ－ ａＣＯ２ 变化不同，再灌注期间全身氧指标和血流动力学基本恢复至休克前水平。结论：休克缺血及再灌注时肠道持续低灌注及氧合障碍，ｐＨｉ及Ｐｉ－ ａＣＯ２ 是反映该状态特异灵敏的指标。Objective:To investigate changes in colonic intramucosal pH (pHi) and PCO 2 gradient between colonic mucosa and arterial blUsing a rabbit model of hemorrhagic shockreperfusion,sigmoid colon pHi and P i-a CO 2,hemodynamics,oxygen variables were measured simultaneously before shock(S 0) and 1 hour after shock (S 1),1 hour and 2 hours of reperfusion (REP 1,REP 2).Histologic alterations in colonic tissue were examined under light microscope.Results: Sigmoid colon pHi during shock was significantly lower than that of control and preshock groups,while sigmoid colon P i-a CO 2 was obviously higher than that of control and preshock groups ( P <0 01).There was no difference in pHi and P i-a CO 2 levels between shock (1 hour) and time points of reperfusion ( P >0 05) .During reperfusion,hemodynamics and oxygen variables recovered attaining control and preshock values.A good positive correlation between colonic tissue damage and pHi was found at REP 2.Conclusions:These findings demonstrate that there is a low tissue oxygenation and hypoperfusion in digestive tract during shock and reperfusion,and pHi and P i-a CO 2 are better indicators for this status.

关 键 词：休克 低血容量性 损伤 缺血再灌注 肠粘膜 

分 类 号：R446[医药卫生—诊断学]