Blood pH level modulates organ metabolism of lactate in septic shock in dogs
Blood pH level modulates organ metabolism of lactate in septic shock in dogs
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DOI：
10.1053/jcrc.2002.35816
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发表时间：
2002-09-01
影响因子：
3.7
通讯作者：
Mink, SN
中科院分区：
文献类型：
--
作者：
Chrusch, C;Bautista, E;Mink, SN
目的：乳酸酸中毒是感染性休克的重要并发症。碱治疗，如碳酸氢钠，通常用于治疗脓毒症中出现的低pH值。这种治疗对乳酸（Lac）清除率的影响尚不清楚。在本研究中，目的是检查血液pH值是否改变脓毒症的乳糖代谢。在犬大肠杆菌败血症模型中，在推注（5 mmol/kg）乳酸（LA）或乳酸钠（NaL）后测定测量值。在一个制备，紫胶吸收内脏器官（SP），肝，肺，肾（基德），和下肢（SOL）的软组织进行了初步测定，而在另一个制备，紫胶吸收的头部和颈部区域和肺是gained.Methods：狗进行了研究，而麻醉和通气。脓毒症4小时后，通过位于脓毒症组（SepLA，SepNaL）和非脓毒症组（ConLA，COnNaL）腹主动脉中的导管给予LA或NaL（每种制剂n约为6）。使用导管和流量探针测量器官Lac摄取。在输注结束时和输注后15分钟的时间间隔，直到75分钟后infusing.Results：在脓毒症组的乳酸菌的动脉清除慢，与非脓毒症组相比。在肝脏中，脓毒症抑制摄取LA相比，nonseptic组。在SP中，败血症和pH值都影响Lac的吸收，其中仅在非败血症组中输注NaL后才发现吸收增加。在头部和颈部区域，紫胶吸收是pH值依赖性的，并发现后，在脓毒症和非脓毒症组LA输注。在肺中，在所有组中LA或NaL输注后产生Lac。Kid和SOL均未对Lac摄取产生影响。结论：脓毒症时乳酸清除率降低。pH值和脓毒症的影响调节器官吸收紫胶在脓毒症休克。本研究中测量的器官仅占输注的总Lac的少量。这表明，其他器官可能占乳酸清除败血症。版权所有2002，爱思唯尔科学（美国）。All rights reserved.
Objective: Lactic acidosis is an important complication of septic shock. Alkali treatment such as sodium bicarbonate is often used to treat the low pH level that develops in sepsis. The effect of this treatment on lactate (Lac) clearance is not clear. In the present study, the objective was to examine whether blood pH level alters Lac metabolism in sepsis. Measurements were determined in a canine model of Escherichia coli sepsis after bolus infusion (5 mmol/kg) of either lactic acid (LA) or sodium lactate (NaL). In one preparation, Lac uptake by the splanchnic organs (SP), liver, lung, kidneys (Kid), and soft tissues of the lower extremity (SOL) was primarily determined, whereas in another preparation, Lac uptake by the head and neck region and lung was obtained.Methods: The dogs were studied while anesthetized and ventilated. After 4 hours of sepsis, either LA or NaL was given through a catheter positioned in the abdominal aorta in respective sepsis (SepLA, SepNaL) and nonsepsis groups (ConLA, COnNaL) (n approximate to 6 in each preparation). Catheters and flow probes were used to measure organ Lac uptake. Measurements were obtained at end infusion and at 15-minute intervals after infusion until 75 minutes after infusion.Results: Arterial clearance of Lac in the sepsis groups was slower as compared with the nonsepsis groups. In the liver, sepsis inhibited the uptake of LA as compared with the nonseptic group. In SP, both sepsis and pH affected Lac uptake in which an increase in uptake was found only after NaL infusion in the nonseptic group. In the head and neck region, Lac uptake was pH-level dependent and was found after LA infusion in the sepsis and nonsepsis groups. In the lung, Lac was produced after either LA or NaL infusion in all groups. Neither Kid nor SOL contributed to Lac uptake in any of the groups.Conclusion: Lactate clearance was reduced in sepsis. Both effects of pH level and sepsis modulated the organ uptake of Lac in septic shock. Only a small amount of the total Lac infused could be accounted for by the organs measured in the present study. This suggests that additional organs may account for lactate removal in sepsis. Copyright 2002, Elsevier Science (USA). All rights reserved.