N-acetylcysteine increases liver blood flow and improves liver function in septic shock patients:: Results of a prospective, randomized, double-blind study
N-acetylcysteine increases liver blood flow and improves liver function in septic shock patients:: Results of a prospective, randomized, double-blind study
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DOI：
10.1097/00003246-200012000-00006
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发表时间：
2000-12-01
影响因子：
8.8
通讯作者：
Spies, C
中科院分区：
文献类型：
--
作者：
Rank, N;Michel, C;Spies, C
目的：在败血症棚屋，内脏血流量减少的报道，尽管有足够的全身血流动力学。在实验环境中，N-乙酰半胱氨酸(NAC)可增加肝内脏血流量。在感染性休克患者中，NAC改善了吲哚青绿的清除和全身耗氧量与需氧量的关系。我们研究了NAC对感染性休克早期肝血流、肝内脏氧转运相关变量和肝功能的影响。设计：前瞻性、随机、双盲研究，地点：败血症休克患者住进跨学科外科重症监护病房。患者：我们检查了60名败血症休克患者，在败血症发病后24小时内。所有受试者均按常规进行容量复苏和正压复苏，情况稳定，胃内插入胃张力计，肝静脉插管，用单乙基甘氨酸二乙酯(MEGX)的血浆表象评估微粒体肝功能。干预：受试者随机接受150 mg/kg NAG持续15分钟静脉注射，然后继续静脉滴注12.5 mg/kg/hr NAC超过90分钟(n=30)或安慰剂(n=30)，测量和主要结果：在开始输液前(基线)和开始后60分钟(输液)，肝脏绝对血流指数明显升高(2.7vs.3.3 L/分钟/m~2)；P=.01)和心脏指数(5.0vs.5.7 L/分钟/米(2)；P=0.02)。分数肝血流指数(心脏指数相关的河流血流指数)无变化。动脉和胃粘膜二氧化碳分压差值降低(p=0.05)，MEGX升高(p=0.04)。肝血流指数与MEGX呈显著正相关(r(S)=0.57；P<0.01)。结论：NAG治疗后，肝内脏血流和功能均有改善，提示营养血流量增加。肝血流指数的增加不是由于再分布到肝内脏区域，而是由于心脏指数的增加。由于其与肝血流指数的相关性，MEGX可能有助于确定早期感染性休克患者是否受益于NAC治疗。
Objective: In septic shack, decreased splanchnic blood flow is reported, despite adequate systemic hemodynamics. N-acetylcysteine (NAC) was found to increase hepatosplanchnic blood flow in experimental settings. In septic shock patients, NAC improved the clearance of indocyanine green and the relationship of systemic oxygen consumption to oxygen demand. We investigated the influence of NAC on liver blood flow, hepatosplanchnic oxygen transport-related variables, and liver function during early septic shock.Design: Prospective, randomized, double-blind study,Setting: Septic shock patients admitted to an interdisciplinary surgical intensive care unit.Patients: We examined 60 septic shock patients within 24 hrs after onset of sepsis. They were conventionally resuscitated with volume and inotropes and were in stable condition, A gastric tonometer was inserted into the stomach and a catheter into the hepatic vein, Microsomal liver function was assessed by using the plasma appearance of monoethylglycinexylidide (MEGX).Interventions: Subjects randomly received either a bolus of 150 mg/kg iv NAG over 15 mins and a subsequent continuous infusion of 12.5 mg/kg/hr NAC over 90 mins (n = 30) or placebo (n = 30),Measurements and Main Results: Measurements were performed before (baseline) and 60 mins after beginning the infusion (infusion), After NAG, a significant increase in absolute liver blood flow index (2.7 vs. 3.3 L/min/m(2); p = .01) and cardiac index (5.0 vs. 5.7 L/min/m(2); p = .02) was observed. Fractional liver blood flow index (cardiac index-related river blood flow index) did not change. The difference between arterial and gastric mucosal carbon dioxide tension decreased (p = .05) and MEGX increased (p = .04). Liver blood flow index and MEGX correlated significantly (r(s) = .57; p less than or equal to .01).Conclusions: After NAG treatment, hepatosplanchnic flow and function improved and may, therefore, suggest enhanced nutritive blood flow. The increase of liver blood flow index was not caused by redistribution to the hepatosplanchnic area, but by an increase of cardiac index. Because of its correlation with liver blood flow index, MEGX may be helpful in identifying patients who benefit from NAC treatment in early septic shock.