Hypotension during Fluid-restricted Abdominal Surgery Effects of Norepinephrine Treatment on Regional and Microcirculatory Blood Flow in the Intestinal Tract
Hypotension during Fluid-restricted Abdominal Surgery Effects of Norepinephrine Treatment on Regional and Microcirculatory Blood Flow in the Intestinal Tract
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DOI：
10.1097/aln.0b013e31820bfc81
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发表时间：
2011-03-01
期刊：
影响因子：
8.8
通讯作者：
Brandt, Sebastian
中科院分区：
文献类型：
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作者：
Hiltebrand, Luzius B.;Koepfli, Eliana;Brandt, Sebastian
背景：血管升压药，如去甲肾上腺素，经常用于治疗围手术期低血压。用去甲肾上腺素增加灌注压可能会增加危险区域的血流量。然而，由此产生的血管收缩可能会恶化肠道和肾脏的微循环血流。本动物研究旨在探讨剖腹手术期间用低容量补液治疗去甲肾上腺素治疗围手术期低血压的效果。方法：将 20 只麻醉和通气的猪随机分配到对照组或治疗（去甲肾上腺素）组。两组均接受3毫升。千克（-1）。 h(-1) 乳酸林格溶液。此外，去甲肾上腺素组接受去甲肾上腺素逐步升高血压至65和75毫米汞柱。测量内脏动脉的区域血流量。在小肠和结肠中，使用激光多普勒血流计测量微循环血流量。用壁内Clark型电极测量肠组织氧张力。结果：用去甲肾上腺素将动脉低血压逆转至平均动脉压75mmHg后，肝内脏和肾血流量保持不变。去甲肾上腺素组与对照组相比，空肠（96 +/- 41% vs. 93 +/- 18%）和结肠（98 +/- 19% vs. 97 +/- 28%）和肠道组织氧张力（空肠，45 +/- 13 vs. 43 +/- 5 mmHg；结肠，50）的平均+/- SD微循环血流量 +/- 10 与 45 +/- 8 mmHg）具有可比性。结论：在尽可能接近临床条件的腹部手术模型中，用去甲肾上腺素治疗围手术期低血压对肠道微循环血流或组织氧张力没有不良影响。
Background: Vasopressors, such as norepinephrine, are frequently used to treat perioperative hypotension. Increasing perfusion pressure with norepinephrine may increase blood flow in regions at risk. However, the resulting vasoconstriction could deteriorate microcirculatory blood flow in the intestinal tract and kidneys. This animal study was designed to investigate the effects of treating perioperative hypotension with norepinephrine during laparotomy with low fluid volume replacement.Methods: Twenty anesthetized and ventilated pigs were randomly assigned to a control or treatment (norepinephrine) group. Both groups received 3 ml . kg(-1) . h(-1) Ringer's lactate solution. In addition, the norepinephrine group received norepinephrine to stepwise increase blood pressure to 65 and 75 mmHg. Regional blood flow was measured in the splanchnic arteries. In the small bowel and colon, microcirculatory blood flow was measured using laser Doppler flowmetry. Intestinal tissue oxygen tension was measured with intramural Clark-type electrodes.Results: Hepatosplanchnic and kidney blood flow remained unchanged after reversal of arterial hypotension to a mean arterial pressure of 75 mmHg with norepinephrine. For the norepinephrine group versus the control group, the mean +/- SD microcirculatory blood flow in the jejunum (96 +/- 41% vs. 93 +/- 18%) and colon (98 +/- 19% vs. 97 +/- 28%) and intestinal tissue oxygen tension (jejunum, 45 +/- 13 vs. 43 +/- 5 mmHg; colon, 50 +/- 10 vs. 45 +/- 8 mmHg) were comparable.Conclusions: In this model of abdominal surgery in which clinical conditions were imitated as close as possible, treatment of perioperative hypotension with norepinephrine had no adverse effects on microcirculatory blood flow or tissue oxygen tension in the intestinal tract.