动静脉血pH和二氧化碳分压差与胃粘膜pH监测组织氧合相关性的实验研究  

The correlation between gastric intramucosal pH and arteriovenous differences in pH,partial pressure of carbon dioxide in rabbits with septic shock

作　　者：阮净[1] 张淑文[1] 袁振铎[1] 靳红[1] 王莘[1] 张宝红[1] 纪华[1] 罗薇[1] 

机构地区：[1]首都医科大学附属北京友谊医院,北京100050

出　　处：《中国危重病急救医学》2000年第2期109-112,共4页Chinese Critical Care Medicine

摘　　要：目的：探讨反应组织氧合状况简便易行而有实用价值的指标。方法：用致病性大肠杆菌（Ｅ．ｃｏｌｉＯ１１１Ｂ４ ）活菌液制备兔感染性休克模型（实验组１０ 只，对照组６ 只注射等量生理盐水），观察实验组与对照组在种菌前、种菌后０．５、１．０、１．５、２．０ 和２．５ 小时平均动脉压（ＭＡＰ）、胃粘膜ｐＨ 值（ｐＨｉ）和动、静脉血ｐＨ（ａ ｖｐＨ）及二氧化碳分压差（ｖ ａＰＣＯ２）的变化及其相关性。结果：１０ 只实验组休克兔中有２ 只在种菌后２．５小时死亡，８ 只在种菌后２．０ 小时ＭＡＰ下降到４．６７ ｋＰａ（１ ｋＰａ＝ ７．５ ｍ ｍ Ｈｇ）以下；实验组在种菌后１．５ 小时ｐＨｉ明显下降，与对照组相比有显著性差异（Ｐ＜ ０．０５）；实验组ｖ ａＰＣＯ２、ａ ｖｐＨ 种菌后逐渐增大，在种菌后２．０ 小时与对照组相比有显著性差异（Ｐ＜ ０．０５）。ｐＨｉ的变化与ｖ ａＰＣＯ２、ａ ｖｐＨ 呈显著负相关（ｒ１ ＝－ ０．７６５，ｒ２＝ － ０．５５１，Ｐ均＜ ０．０１），ａ ｖｐＨ 与ｖ ａＰＣＯ２ 成显著正相关（ｒ＝ ０．７６３，Ｐ＜ ０．０１）。结论：ａ ｖｐＨ、ｖ ａＰＣＯ２ 与ｐＨｉ的变化在兔感染性休克时几乎同时出现，而且随着缺氧程度的不断加重，ａObjective:To assess the relationship between arteriovenous pH (avpH),PCO 2 gradients ( avPCO 2 ) and gastric intramucosal pH (pHi) in rabbits with septic shock,and to seek useful indicators reflecting tissue oxygenation.Methods:Anesthetized New Zealand white rabbits 〔(2 6±0 3)kg〕 were randomly divided into control group ( n =6) and study group ( n =10,receiving an intravenous injection of E.coli O 111 B 4).Gastric tonometry was performed after surgical preparation (30 minutes equilibration) and at 0 5,1 0,1 5,2 0 and 2 5 hours of injection of E.coli O 111 B 4.Simultaneously,arterial and venous blood samples were collected and the saline sample aspirated from the balloon tonometry,parameters including pHi,avpH,as well as avPCO 2 were determined by blood gas analyzers.In addition,mean arterial pressure (MAP) were recorded.Results:In the study group,2 of 10 animals died within 2 5 hours after bacterial challenge,and MAP decreased below 4 67 kPa(1 kPa=7 5 mmHg) at 2 hours in 8 animals.pHi values significantly decreased compared to control group at 1 5 hours after injection of E.coli O 111 B 4.2 hours after E.coli O 111 B 4 challenge,marked elevation of vaPCO 2 and avpH was observed in the study group compared to the controls.There were negative correlations between pHi and vaPCO 2,avpH ( r 1=-0 765, r 2=-0 551,both P <0 01),and positive correlation between vaPCO 2 and avpH ( r =0 763, P <0 01).Conclusions:Our results demonstrate that there is a significant correlation between vaPCO 2 and pHi.The changes in avpH, vaPCO 2 and pHi were evident simultaneously in experimental rabbits during septic shock.Accompanied with tissue hypoxia,avpH, vaPCO 2 progressively increased while pHi decreased.Measurement of avpH,vaPCO 2 gradients appears to be easy and without time limitation,therefore these parameters may be promising in detecting tissue oxygenation in clinical practice.

关 键 词：静脉血pH 二氧化碳分压差 胃粘膜PH 组织氧合 

分 类 号：R446[医药卫生—诊断学]