Hemodynamics of pancreatic ischemia in cardiogenic shock in pigs.
Hemodynamics of pancreatic ischemia in cardiogenic shock in pigs.
复制标题
猪心源性休克胰腺缺血的血流动力学。
DOI：
10.1016/s0016-5085(97)70190-2
复制
发表时间：
1997
期刊：
影响因子：
29.4
通讯作者：
Bulkley,GB
中科院分区：
文献类型：
--
作者：
Reilly,PM;Toung,TJ;Miyachi,M;Schiller,HJ;Bulkley,GB
背景和目的先前的研究表明，肾素-血管紧张素轴在心源性休克时胃、肠和肝循环的血管收缩中起关键作用。本研究旨在探讨心包填塞致心源性休克时胰腺缺血的基本血流动力学机制。方法心包填塞致心源性休克。心输出量（和总外周血管阻力）通过热稀释测定。用放射性标记微球测定胰腺血流（和血管阻力）。结果心包压逐渐升高导致相应的心输出量下降至基线的42% +/- 1%，动脉压下降至基线的67% +/- 3%，外周血管总阻力增加至基线的146% +/- 5%。胰腺血流量不成比例地下降到基线的30% +/- 3%，因为胰腺血管阻力不成比例地增加到基线的220% +/- 19%。先前证实的阻断肾素-血管紧张素轴可消除这种反应，而证实阻断α -肾上腺素能系统或抗利尿激素系统则无显著影响。在没有休克的情况下，中心静脉输注血管紧张素II密切模仿这种选择性血管收缩。结论肝紧张素介导的选择性胰腺血管收缩导致心源性休克时胰腺缺血。（胃肠病学1997 Sep；113(3):938-45）
BACKGROUND & AIMSPrevious studies have shown that the renin- angiotensin axis plays a pivotal role in vasoconstriction of the gastric, intestinal, and hepatic circulations during cardiogenic shock. The aim of this study was to evaluate the fundamental hemodynamic mechanism of pancreatic ischemia during cardiogenic shock induced by pericardial tamponade.METHODSCardiogenic shock was induced by pericardial tamponade. Cardiac output (and total peripheral vascular resistance) was determined by thermodilution. Pancreatic blood flow (and vascular resistance) was determined with radiolabeled microspheres.RESULTSGraded increases in pericardial pressure produced corresponding decreases in cardiac output to 42% +/- 1% and arterial pressure to 67% +/- 3% of baseline and increases in total peripheral vascular resistance to 146% +/- 5% of baseline. Pancreatic blood flow decreased disproportionately to 30% +/- 3% of baseline, because of a disproportionate increase in pancreatic vascular resistance to 220% +/- 19% of baseline. Previously confirmed blockade of the renin-angiotensin axis ablated this response, whereas confirmed blockade of the alpha-adrenergic system or vasopressin system had no significant effect. Without shock, central intravenous infusions of angiotensin II closely mimicked this selective vasoconstriction.CONCLUSIONSAngiotensin-mediated selective pancreatic vasoconstriction results in significant pancreatic ischemia during cardiogenic shock. (Gastroenterology 1997 Sep;113(3):938-45)