NEUROHORMONAL REGULATION OF SYSTEMATIC HEMOSTATIC FUNCTION

心脏手术后高达15%的患者会发生原因不明的酸中毒，因为这种疾病会自动消失，而有和没有乳酸酸中毒的患者的心输出量相似，这很可能代表了2型乳酸酸中毒。关于这种明显的2型乳酸中毒的机制目前知之甚少。这项研究源于先前关于神经激素调节全身止血功能的研究，旨在评估应激激素对酸碱平衡和乳酸浓度的影响。在最初的止血功能研究中，志愿者在随机接受含有肾上腺素、皮质醇、胰升糖素、血管紧张素II和血管加压素的应激激素注射时，出现明显的2型乳酸血症。随后，我们研究了接受应激激素注射的健康志愿者，其中包括所有的f激素，四种激素(不含血管紧张素II)，三种激素(不含血管紧张素或加压素)，在所有这些注射过程中，志愿者都出现了相同程度的明显的2型乳酸酸中毒。目前，我们正在研究单独服用肾上腺素的健康志愿者。最初的志愿者也患上了II型乳酸酸中毒，考虑到常规评估术后乳酸酸中毒的费用，我们迫切希望评估后续的志愿者。

Unexplained acidosis occurs in up to 15% of patients following cardiac surgery, Since this disorder resolves spontaneously and cardiac output is similar in patients with and without lactic acidosis, it is likely this represents a type 2 lactic acidosis. Little is presently known regarding the mechanism responsible for this apparent Type 2 lactic acidosis. This study, which stems from a previous investigation on the neurohormonal regulation of systemic hemostatic function, is designed to evaluate the impact of stress hormones on acid-base balance and lactate concentrations. Volunteers in the original study on hemostatic function were noted to develop an apparent Type 2 lactic acidosis when randomized to the stress hormone infusion that contained epinephrine, cortisol, glucagon, angiotensin Ii, and vasopressin. Subsequently we have studied healthy volunteers receiving stress hormone infusion of all f hormones, four hormones (without angiotensin II), three hormones (without angiotensin or vasopressin) and during all of these infusions the volunteers have developed an apparent Type 2 lactic acidosis of the same magnitude. Presently we are studying healthy volunteers receiving epinephrine alone. The initial volunteer also has developed a type 2 lactic acidosis and given the cost of routinely evaluating postoperative lactic acidosis we are eager to evaluate subsequent volunteers.