感染性休克犬应用亚甲蓝对肠道灌注和氧合的影响  

Effects of Methylene Blue on Intestinal Perfusion and Oxygenation in Dogs With Septic Shock

作　　者：任同悦[1] 李媛[2] 王方[1] 王业贵[1] 陈健[1] 陈菲[1] 

机构地区：[1]天津市第四中心医院麻醉科,天津300142 [2]天津市第四医院急诊科

出　　处：《中国医师杂志》2003年第9期1213-1214,1218,共3页Journal of Chinese Physician

摘　　要：目的　研究鸟苷酸环化酶抑制药亚甲蓝对感染性休克犬肠道灌注和氧合的影响。方法　静脉注入内毒素诱导的 7只感染性休克犬模型 ,输注 0 9%氯化钠复苏后 15min内注入亚甲蓝 2mg/kg。血流量仪测定基础、休克 1h后、复苏后和亚甲蓝注入后 3 0min肠系膜上动脉血流量。分析动脉和肠系膜上静脉血气 ,计算肠道氧合。结果　犬感染性上动脉 (肠道 )血流减少 61 8% (P<0 0 1) ,氧输送 (DO2 )减少 62 1% (P <0 0 1) ,氧摄取 (O2 extr)增加 2 3 5 %。复苏至肺动脉嵌压为 ( 12 1± 1 4)mmHg后 ,肠道血流增加 5 4 6% (P <0 0 1) ,DO2 增加 12 8% (P <0 0 1) ,O2 extr增加 2 0 9%。亚甲蓝注入后 ,肠道血流增加 19 4% (P <0 0 1) ,DO2 则无明显变化 ( P >0 0 5 ) ,O2 extr增加 14 8%。结论　感染性休克后肠道血流灌注减少 ,氧耗增加 ;液体复苏仅部分恢复肠道灌注 ;Objective To study the effects of methylene blue(MB), a soluble guanylate cyclase inhibitor , on intestinal perfusion and oxygenation in dogs with septic shock.Methods A septic shock model was established by lipopolysaccharide infusion.After resuscitation with normal saline infusion,2mg/kg MB was infused within 15min in seven dogs.Blood flow of the superior mesenteric artery (SMA) was measured respectively at baseline,post shock for 1h, after resuscitation and 30min after MB injection.Blood gas analysis was done , and oxygenation was calculated.Results Blood flow of the SMA was significantly decreased by 61 8%(P<0 01) in dogs with septic shock ,oxygen delivery(DO 2) was decreased by 62 1%(P<0 01) and oxygen extraction (O 2extr) was increased by 20 9%. When pulmonary artery wedge pressure reached a level of (12 1±1 4)mmHg with fluid resusciation , blood flow of the SMA was significantly increased by 54 6%(P<0 01), DO 2 increased by 12 8%(P<0 01) , and O 2extr increased by 23 5%.After MB infusion ,blood flow of the SMA was increased by 19 4%(P<0 01).DO 2 kept unchanged(P >0 0 5 ) ,butO2 extrincreasedby 14 8% .Conclusions Septicshockindogsresultsinadecreaseinintestinalperfusionandanincreasein oxygenextraction ,whichcanbeimprovedbyMBinjection .Theintestinalperfusionispartlyincreasedbyvolumetherapy .

关 键 词：感染性休克 肠道血流灌注 氧合 亚甲蓝 

分 类 号：R631.4[医药卫生—外科学]