Stomach, liver, kidney and skeletal muscle autoregulation evaluated by near-infrared spectroscopy in a swine model
Stomach, liver, kidney and skeletal muscle autoregulation evaluated by near-infrared spectroscopy in a swine model
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DOI：
10.1007/s10877-022-00956-5
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发表时间：
2023-01-04
影响因子：
2.2
通讯作者：
Nakajima, Yoshiki
中科院分区：
文献类型：
--
作者：
Kurita, Tadayoshi;Kawashima, Shingo;Nakajima, Yoshiki
目的不同的器官对血压变化和/或循环量变化具有不同的自动调节能力。本研究使用近红外光谱 (NIRS) 评估了基线、低血容量和液体复苏后条件下胃、肝、肾和骨骼肌的自动调节。方法 用 2.5% 异氟烷麻醉 10 头猪（体重 24.5 +/- 0.5 kg），并给予 0.5、1、2 和 5 μg kg(-)(1)每 10 分钟间隔一次 min(-)(1) 去氧肾上腺素，然后类似地逐步输注硝普钠 (SNP)，以诱导较宽范围的平均动脉压 (MAP)。诱导出血 600 毫升以产生低血容量状态，仅重新给予去氧肾上腺素。输注羟乙基淀粉(600ml)以创造液体复苏后的条件，并重新施用去氧肾上腺素和SNP。评估平均动脉压（MAP）与各组织氧合指数（TOI）之间的平均关系，并根据每次血管活性药物输注期间MAP与TOI之间的相关系数来评估个体关系。 结果基于使用各TOI代替血流量的评估，肾脏自动调节功能强大，与肌肉相似，但具有显着的下限。胃的自动调节能力比肾脏和肌肉弱。肝脏没有自我调节功能。肾脏 TOI 对容量条件变化的响应变化比胃和肝脏 TOI 大 2 倍。 结论 在我们基于 NIRS 的自动调节能力评估中，肝脏氧合高度依赖血压，肾脏高度敏感，骨骼肌对低血压和容量损失高度耐受。
Purpose Different organs have different autoregulatory capacities for blood pressure changes and/or circulatory volume changes. This study assessed the autoregulation of the stomach, liver, kidney and skeletal muscle, under baseline, hypovolemic, and post-fluid-resuscitation conditions using near-infrared spectroscopy (NIRS).Methods Ten pigs (bodyweight 24.5 +/- 0.5 kg) were anesthetized with 2.5% isoflurane and administered 0.5, 1, 2 and 5 mu g kg(-)(1) min(-)(1) of phenylephrine at 10-min intervals, followed by similar stepwise infusion of sodium nitroprusside (SNP) to induce a wide range of mean arterial pressures (MAPs). A 600-ml bleed was induced to create the hypovolemic condition, and only phenylephrine was re-administered. Hydroxyethyl starch (600 ml) was infused to create the post-fluid-resuscitation condition, and phenylephrine and SNP were re-administered. Average relationships between mean arterial pressure (MAP) and each tissue oxygenation index (TOI) were assessed, and the individual relationships were evaluated based on the correlation coefficients between MAP and TOI during each vasoactive drug infusion.Results Based on the evaluation using each TOI as a substitute of blood flow, the kidney autoregulation was robust, similar to muscle, but had a prominent lower limit. The stomach had weaker autoregulation than the kidney and muscle. The liver had no autoregulation. The kidney TOI showed 2-fold greater changes in response to volume condition changes than the stomach and liver TOIs.Conclusion In our NIRS-based assessment of autoregulatory capacity, the liver oxygenation is highly blood pressure dependent, and the kidney is highly susceptible and the skeletal muscle is highly tolerable to low blood pressure and volume loss.