AIM:Microcirculatory disturbances are important early pathophysiological events in various organs during acute pancreatitis.The aim of the study was to evaluate changes in microperfusion of the pancreas,liver,kidney,s...AIM:Microcirculatory disturbances are important early pathophysiological events in various organs during acute pancreatitis.The aim of the study was to evaluate changes in microperfusion of the pancreas,liver,kidney,stomach, colon,skeletal muscle,and to investigate the influence of heparin on the organ microcirculation in caerulein-induced experimental acute pancreatitis. METHODS:Acute pancreatitis was induced by 4 intraperitoneal injections of caerulein(Cn)(15 μg/kg).The organ microcirculation was measured by laser Doppler flowmetry.Serum interleukin 6 and hematocrit levels were analysed. RESULTS:Acute pancreatitis resulted in a significant drop of microperfusion in all examined organs.Heparin administration(2×2.5 mg/kg)improved the microcirculation in pancreas(36.9±4% vs 75.9±10%),liver(56.6±6% vs 75.2±16%),kidney (45.1±6% vs 79.3±5%),stomach (65.2±8% vs 78.1±19%),colon(69.8±6% vs 102.5±19%), and skeletal muscle (59.2±6% vs 77.9±13%).Heparin treatment lowered IL-6(359.0±66 U/mL vs 288.5±58 U/mL) and hematocrit level(53±4% vs 46±3%). CONCLUSION:Heparin administration has a positive influence on organ microcirculatory disturbances accompanying experimental Cn-induced acute pancreatitis.展开更多
AIM:To study the effect of circulating cell-free oxy-hemoglobin(FHb) on intestinal microcirculation and intestinal epithelial injury in a rat model. METHODS:To induce elevated intravascular circulating FHb,male Spragu...AIM:To study the effect of circulating cell-free oxy-hemoglobin(FHb) on intestinal microcirculation and intestinal epithelial injury in a rat model. METHODS:To induce elevated intravascular circulating FHb,male Sprague-Dawley rats received water or FHb infusion.Microcirculatory changes in jejunum,ileum and colon were evaluated using fluorescent microspheres.Intestinal injury was quantified as plasmatic release of ileal lipid binding protein(iLBP) and verified by histological analysis of the ileum. RESULTS:Water and FHb infusions resulted,when compared with saline infusion,in reduced intestinal microcirculation(after 30 min P<0.05,or better;after 60 min FHb infusion P<0.05 for jejunum and colon) .Circulating FHb levels correlated significantly with release of iLBP(Spearman r=0.72,P=0.0011) .Epithelial cell injury of the villi was histologically observed after water and FHb infusions. CONCLUSION:This study shows that circulating FHb leads to a reduction in intestinal microcirculatory blood flow with marked injury to intestinal epithelial cells. These data support the hypothesis that circulating FHb contributes to the development of intestinal injury.展开更多
The main reason for the death of the patient with acute hemorrhage necrosis pancreatitis (AHNP) is pancreatic infection and multi-organ failure caused by endotoxemia and intestinal bacterial translocation[1-7]. Howeve...The main reason for the death of the patient with acute hemorrhage necrosis pancreatitis (AHNP) is pancreatic infection and multi-organ failure caused by endotoxemia and intestinal bacterial translocation[1-7]. However, the pathogenesis of endotoxemia and intestinal bacterial translocation remains a question[8-10]; moreover, no effective method of prevention and cure for it has been found till now[11 -15] In the present study, we infused low dose dopamine and low molecular weight dextran through the catheters to abdominal aorta and portal vein, and observed its influence on the endotoxin concentration in plasma and the rate of translocation of intestinal bacteria in AHNP rats.展开更多
AIM: To evaluate the currently available evidence on thoracic epidural anesthesia effects on splanchnic macro and microcirculation, in physiologic and pathologic conditions.METHODS:A Pub Med search was conducted using...AIM: To evaluate the currently available evidence on thoracic epidural anesthesia effects on splanchnic macro and microcirculation, in physiologic and pathologic conditions.METHODS:A Pub Med search was conducted using the Me SH database.Anesthesia,Epidural was always the first MeS H heading and was combined by boolean operator AND with the following headings:Circulation,Splanchnic;Intestines;Pancreas and Pancreatitis;LiverFunction Tests.EMBASE,Cochrane library,ClinicalT rials.gov and clinicaltrialsregister.eu were also searched using the same terms.RESULTS:Twenty-seven relevant studies and four ongoing trials were found.The data regarding the effects of epidural anesthesia on splanchnic perfusion are conflicting.The studies focusing on regional macro-hemodynamics in healthy animals and humans undergoing elective surgery,demonstrated no influence or worsening of regional perfusion in patients receiving thoracic epidural anesthesia(TEA).On the other hand most of the studies focusing on micro-hemodynamics,especially in pathologic low flow conditions,suggested that TEA could foster microcirculation.CONCLUSION:The available studies in this field are heterogeneous and the results conflicting,thus it is difficult to draw decisive conclusions.However there is increasing evidence deriving from animal studies,that thoracic epidural blockade could have an important role in modifying tissue microperfusion and protecting microcirculatory weak units from ischemic damage,regardless of the effects on macro-hemodynamics.展开更多
目的探讨肾脏超声造影定量参数预测脓毒症患者器官功能障碍的临床价值。方法连续纳入我院重症医学科收治的51例脓毒症患者(脓毒症组),另选同期17例行肾脏超声造影检查且无肾脏疾病的健康体检者(对照组)。比较两组肾脏超声造影定量参数...目的探讨肾脏超声造影定量参数预测脓毒症患者器官功能障碍的临床价值。方法连续纳入我院重症医学科收治的51例脓毒症患者(脓毒症组),另选同期17例行肾脏超声造影检查且无肾脏疾病的健康体检者(对照组)。比较两组肾脏超声造影定量参数包括达峰时间(TTP)、峰值强度(PI)、曲线下面积(AUC),以及临床资料的差异。根据序贯器官衰竭(SOFA)评分对脓毒症患者进行分组,定义入ICU 0~24 h SOFA>6分为器官功能严重衰竭,将患者分为严重组与非严重组;定义入ICU 24~48 h SOFA评分增加(ΔSOFA评分≥1)为器官功能恶化,将患者分为恶化组与未恶化组;同时根据入ICU后的存活情况分为死亡组与存活组。比较各亚组间TTP、AUC、PI的差异。绘制受试者工作特征(ROC)曲线分析各指标预测脓毒症患者器官功能严重衰竭的诊断效能。结果脓毒症组与对照组血乳酸(Lac)、氧合指数、SOFA评分、使用血管活性药物、估算肾小球滤过率、尿素氮,以及TTP、AUC、PI比较差异均有统计学意义(均P<0.05)。脓毒症患者中,严重组27例,非严重组24例;恶化组14例,非恶化组37例;严重组与非严重组、恶化组与未恶化组AUC、PI比较差异均有统计学意义(均P<0.05)。脓毒症患者中,死亡组14例,存活组37例;两组各超声造影参数比较差异均无统计学意义。ROC曲线分析显示,AUC、PI、Lac预测脓毒症患者器官功能严重衰竭的曲线下面积分别为0.81、0.75、0.73。结论肾脏超声造影定量参数可用于监测脓毒症患者器官功能衰竭的严重程度及进展,对脓毒症患者器官功能障碍有一定的预测价值。展开更多
急性胰腺炎(acute pancreatitis,AP)发病机制之一是微循环障碍.精氨酸(arginine,Arg)及生长抑素对 AP 胰腺微循环障碍的保护作用已受到重视,但对影响微循环的血液流变学改变尚缺乏研究.我们探讨 AP 时精氨酸、生长抑素对血液流变学的影...急性胰腺炎(acute pancreatitis,AP)发病机制之一是微循环障碍.精氨酸(arginine,Arg)及生长抑素对 AP 胰腺微循环障碍的保护作用已受到重视,但对影响微循环的血液流变学改变尚缺乏研究.我们探讨 AP 时精氨酸、生长抑素对血液流变学的影响以及血流变学异常与胰腺、胰外多器官损害的相关性,为临床治疗提供应用基础.展开更多
基金Supported by Medical University of Gda■sk,grant W-120,Poland
文摘AIM:Microcirculatory disturbances are important early pathophysiological events in various organs during acute pancreatitis.The aim of the study was to evaluate changes in microperfusion of the pancreas,liver,kidney,stomach, colon,skeletal muscle,and to investigate the influence of heparin on the organ microcirculation in caerulein-induced experimental acute pancreatitis. METHODS:Acute pancreatitis was induced by 4 intraperitoneal injections of caerulein(Cn)(15 μg/kg).The organ microcirculation was measured by laser Doppler flowmetry.Serum interleukin 6 and hematocrit levels were analysed. RESULTS:Acute pancreatitis resulted in a significant drop of microperfusion in all examined organs.Heparin administration(2×2.5 mg/kg)improved the microcirculation in pancreas(36.9±4% vs 75.9±10%),liver(56.6±6% vs 75.2±16%),kidney (45.1±6% vs 79.3±5%),stomach (65.2±8% vs 78.1±19%),colon(69.8±6% vs 102.5±19%), and skeletal muscle (59.2±6% vs 77.9±13%).Heparin treatment lowered IL-6(359.0±66 U/mL vs 288.5±58 U/mL) and hematocrit level(53±4% vs 46±3%). CONCLUSION:Heparin administration has a positive influence on organ microcirculatory disturbances accompanying experimental Cn-induced acute pancreatitis.
基金Supported by The Profileringsfonds of the Maastricht University Medical Center(to Jacobs MJ and Buurman WA)an AGIKO-stipendium 920-03-522(to Lubbers T)from The Netherlands Organization for Health Research and Development
文摘AIM:To study the effect of circulating cell-free oxy-hemoglobin(FHb) on intestinal microcirculation and intestinal epithelial injury in a rat model. METHODS:To induce elevated intravascular circulating FHb,male Sprague-Dawley rats received water or FHb infusion.Microcirculatory changes in jejunum,ileum and colon were evaluated using fluorescent microspheres.Intestinal injury was quantified as plasmatic release of ileal lipid binding protein(iLBP) and verified by histological analysis of the ileum. RESULTS:Water and FHb infusions resulted,when compared with saline infusion,in reduced intestinal microcirculation(after 30 min P<0.05,or better;after 60 min FHb infusion P<0.05 for jejunum and colon) .Circulating FHb levels correlated significantly with release of iLBP(Spearman r=0.72,P=0.0011) .Epithelial cell injury of the villi was histologically observed after water and FHb infusions. CONCLUSION:This study shows that circulating FHb leads to a reduction in intestinal microcirculatory blood flow with marked injury to intestinal epithelial cells. These data support the hypothesis that circulating FHb contributes to the development of intestinal injury.
基金the China Postdoctoral Sciences Foundation No C.P.S.F 1996.2~#
文摘The main reason for the death of the patient with acute hemorrhage necrosis pancreatitis (AHNP) is pancreatic infection and multi-organ failure caused by endotoxemia and intestinal bacterial translocation[1-7]. However, the pathogenesis of endotoxemia and intestinal bacterial translocation remains a question[8-10]; moreover, no effective method of prevention and cure for it has been found till now[11 -15] In the present study, we infused low dose dopamine and low molecular weight dextran through the catheters to abdominal aorta and portal vein, and observed its influence on the endotoxin concentration in plasma and the rate of translocation of intestinal bacteria in AHNP rats.
基金Supported by The Department of Anesthesiology of the University of Bologna
文摘AIM: To evaluate the currently available evidence on thoracic epidural anesthesia effects on splanchnic macro and microcirculation, in physiologic and pathologic conditions.METHODS:A Pub Med search was conducted using the Me SH database.Anesthesia,Epidural was always the first MeS H heading and was combined by boolean operator AND with the following headings:Circulation,Splanchnic;Intestines;Pancreas and Pancreatitis;LiverFunction Tests.EMBASE,Cochrane library,ClinicalT rials.gov and clinicaltrialsregister.eu were also searched using the same terms.RESULTS:Twenty-seven relevant studies and four ongoing trials were found.The data regarding the effects of epidural anesthesia on splanchnic perfusion are conflicting.The studies focusing on regional macro-hemodynamics in healthy animals and humans undergoing elective surgery,demonstrated no influence or worsening of regional perfusion in patients receiving thoracic epidural anesthesia(TEA).On the other hand most of the studies focusing on micro-hemodynamics,especially in pathologic low flow conditions,suggested that TEA could foster microcirculation.CONCLUSION:The available studies in this field are heterogeneous and the results conflicting,thus it is difficult to draw decisive conclusions.However there is increasing evidence deriving from animal studies,that thoracic epidural blockade could have an important role in modifying tissue microperfusion and protecting microcirculatory weak units from ischemic damage,regardless of the effects on macro-hemodynamics.
文摘目的探讨肾脏超声造影定量参数预测脓毒症患者器官功能障碍的临床价值。方法连续纳入我院重症医学科收治的51例脓毒症患者(脓毒症组),另选同期17例行肾脏超声造影检查且无肾脏疾病的健康体检者(对照组)。比较两组肾脏超声造影定量参数包括达峰时间(TTP)、峰值强度(PI)、曲线下面积(AUC),以及临床资料的差异。根据序贯器官衰竭(SOFA)评分对脓毒症患者进行分组,定义入ICU 0~24 h SOFA>6分为器官功能严重衰竭,将患者分为严重组与非严重组;定义入ICU 24~48 h SOFA评分增加(ΔSOFA评分≥1)为器官功能恶化,将患者分为恶化组与未恶化组;同时根据入ICU后的存活情况分为死亡组与存活组。比较各亚组间TTP、AUC、PI的差异。绘制受试者工作特征(ROC)曲线分析各指标预测脓毒症患者器官功能严重衰竭的诊断效能。结果脓毒症组与对照组血乳酸(Lac)、氧合指数、SOFA评分、使用血管活性药物、估算肾小球滤过率、尿素氮,以及TTP、AUC、PI比较差异均有统计学意义(均P<0.05)。脓毒症患者中,严重组27例,非严重组24例;恶化组14例,非恶化组37例;严重组与非严重组、恶化组与未恶化组AUC、PI比较差异均有统计学意义(均P<0.05)。脓毒症患者中,死亡组14例,存活组37例;两组各超声造影参数比较差异均无统计学意义。ROC曲线分析显示,AUC、PI、Lac预测脓毒症患者器官功能严重衰竭的曲线下面积分别为0.81、0.75、0.73。结论肾脏超声造影定量参数可用于监测脓毒症患者器官功能衰竭的严重程度及进展,对脓毒症患者器官功能障碍有一定的预测价值。
文摘急性胰腺炎(acute pancreatitis,AP)发病机制之一是微循环障碍.精氨酸(arginine,Arg)及生长抑素对 AP 胰腺微循环障碍的保护作用已受到重视,但对影响微循环的血液流变学改变尚缺乏研究.我们探讨 AP 时精氨酸、生长抑素对血液流变学的影响以及血流变学异常与胰腺、胰外多器官损害的相关性,为临床治疗提供应用基础.
