Cardiac output and organ blood flow in experimental septic shock: effect of treatment with antibiotics, corticosteroids, and fluid infusion.
Cardiac output and organ blood flow in experimental septic shock: effect of treatment with antibiotics, corticosteroids, and fluid infusion.
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实验性感染性休克中的心输出量和器官血流量：抗生素、皮质类固醇和输液治疗的效果。
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发表时间：
1991
期刊：
影响因子：
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通讯作者：
Z. Sándor
中科院分区：
文献类型：
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作者：
J. Ottosson;I. Dawidson;Å. Brandberg;J. Idvall;Z. Sándor
大鼠腹腔 (i.p.) 注射活大肠杆菌引起败血性休克，引起明显的病理生理变化，包括血浆容量 (PV)、心输出量和耗氧量减少 40%，24 小时内死亡率为 100%。本研究评估了单独或联合使用有效抗生素（AB）、血浆容量（PV）扩张和皮质类固醇（CS）治疗感染性休克前后的心输出量和器官血流量。注射细菌后 5.5 小时开始治疗，此时 AB 疗法并未提高 24 小时存活率。脓毒症大鼠的心输出量从 28.6 +/- 3.1 (SD) 下降至 15.4 +/- 2.8 ml/min/kg（P 小于 0.01），同时血流从尸体重新分配到心脏、大脑、肠、肝脏和肾上腺。仅肾上腺和肝脏的绝对动脉血流量分别增加至对照值的 158%（P 小于 0.01）和 167%（P 小于 0.01）。与未经治疗的脓毒症动物相比，单独或联合使用 AB、CS 和林格氏乳酸盐 (RL) 不会显着改善任何器官血流量，但存活率显着提高至约 60%（P 小于 0.01）。白蛋白 (ALB) 和 CS 联合使用可将 PV 扩大至 138%（P 小于 0.01），将心输出量恢复至 100%，并实现大脑 (109%)、肝脏 (125%)、小肠 (147%)（P 小于 0.01）和肾脏（190%）（P 小于 0.01）的超正常血流量值。更重要的是，24 小时存活率为 90% (9/10)（P 小于 0.001）。结论是，在电解质溶液中稀释的胶体与CS和有效的抗生素药物相结合是实验性大肠杆菌败血症成功恢复的必要治疗成分。
Septic shock from intraperitoneal (i.p.) injection of live Escherichia coli bacteria in rats induces marked pathophysiological changes, including 40% decrease in plasma volume (PV), cardiac output, and oxygen consumption with 100% mortality within 24 hr. The present study evaluates cardiac output and organ blood flow before and after treatment of septic shock with an effective antibiotic (AB), plasma volume (PV) expansion, and corticosteroids (CS), alone and in combination. Treatment was initiated at 5.5 hr after bacterial injection, at a time when AB therapy did not improve 24 hr survival rate. Cardiac output decreased from 28.6 +/- 3.1 (SD) to 15.4 +/- 2.8 ml/min/kg (P less than .01) in septic rats concomitant with redistribution of blood flow from carcass to the heart, brain, intestines, liver, and adrenal glands. Absolute arterial blood flow increased only to the adrenal glands and the liver to 158% (P less than .01) and 167% (P less than .01) of control values, respectively. AB, CS, and Ringer's lactate (RL) alone or in combination did not significantly improve any organ blood flow compared to untreated septic animals but increased survival significantly to about 60% (P less than .01). Albumin (ALB) and CS in combination expanded PV to 138% (P less than .01), restored cardiac output to 100%, and achieved supranormal blood flow values to the brain (109%), liver (125%), small intestine (147%) (P less than .01), and kidneys (190%) (P less than .01) of preshock levels. More importantly, survival at 24 hr was 90% (9/10) (P less than .001). It is concluded that a colloid diluted in an electrolyte solution, combined with CS, and an effective antibiotic agent are necessary therapeutic ingredients for the successful recovery of experimental E. coli sepsis.