Sympathetic blockade in a canine model of gram-negative bacterial peritonitis.
Sympathetic blockade in a canine model of gram-negative bacterial peritonitis.
复制标题
革兰氏阴性细菌性腹膜炎犬模型中的交感神经阻滞。
DOI：
10.1097/00024382-200303000-00004
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发表时间：
2003
期刊：
影响因子：
--
通讯作者：
Natanson,Charles
中科院分区：
文献类型：
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作者：
Solomon,StevenB;Banks,StevenM;Gerstenberger,Eric;Csako,Gyorgy;Bacher,JohnD;Thomas3rd,MarvinL;Costello,Rene;Eichacker,PeterQ;Danner,RobertL;Natanson,Charles
我们研究了，在一个完善的犬模型的人败血症，两种不同的技术的交感神经阻滞在细菌性腹膜炎疼痛缓解，血流动力学和生存率的影响。研究了22只专门饲养的比格犬（12-28月龄，体重10-12 kg）。14只动物接受布比卡因和吗啡的硬膜外输注，另外8只接受腹腔神经丛阻滞（n= 4）或假阻滞（n= 4）。22只动物中的18只接受了大肠杆菌（1-10× 10 9 CFU kg− 1体重）的腹腔内激发。在腹腔内植入相当剂量的E.大肠杆菌（2.5-5× 109 CFU kg− 1体重），交感神经阻滞的增加产生了协同降低生存时间（P= 0.002）和平均左心室射血分数（P= 0.008），并增加肌酐水平（P= 0.02）。在脓毒症期间，与交感神经阻滞相关的肿瘤坏死因子（TNF）水平也显著升高（P= 0.004），血液内毒素清除率降低（P= 0.006）。腹腔神经丛阻滞动物的疼痛评分没有改善，主观上看起来比没有腹腔神经丛阻滞的脓毒症动物临床上更差。相比之下，硬膜外阻滞可有效阻断与低致死剂量腹腔内细菌相关的疼痛和不适，与未接受细菌激发的动物相比，疼痛评分未增加。这项研究表明，在严重的细菌性腹膜炎，维持交感神经紧张，无论提供的疼痛缓解是必要的细菌毒素的清除，控制促炎介质的释放，血流动力学稳定，和生存。
We investigated, in a well-established canine model of human sepsis, the effects of two different techniques of sympathetic blockade during bacterial peritonitis on pain relief, hemodynamics, and survival rate. Twenty-two purpose-bred beagles (12–28 months old, weighing 10–12 kg) were studied. Fourteen animals received an epidural infusion of bupivicaine and morphine, and the other eight received either a celiac plexus block (n= 4) or a sham block (n= 4). Eighteen of the 22 animals received an intraperitoneal challenge of Escherichia coli (1–10× 10 9 CFU kg− 1 body weight). At comparable doses of intraperitoneal-implanted E. coli (2.5–5× 10 9 CFU kg− 1 body weight), the addition of sympathetic blockade produced a synergistic decrease in survival times (P= 0.002) and mean left ventricular ejection fraction (P= 0.008), and increase in creatinine levels (P= 0.02). There was also a significant increase in tumor necrosis factor (TNF) levels (P= 0.004) and decrease in blood endotoxin clearance (P= 0.006) associated with sympathetic blockade during sepsis. The celiac plexus-blocked animals had no improvement in pain scores, and subjectively looked clinically worse than animals with sepsis without a celiac plexus block. In contrast, the epidural block was effective in blocking the pain and discomfort associated with low lethality doses of intraperitoneal bacteria reflected by no increase in pain scores compared with animals not receiving bacterial challenge. This study shows that during severe bacterial peritonitis, maintenance of sympathetic tone irrespective of pain relief provided is necessary for clearance of bacterial toxins, control of proinflammatory mediator release, hemodynamic stability, and survival.