Intramucosal pH measurement with tonometers for detecting gastrointestinal ischemia in critically ill patients

为阐明胃张力计作为内脏器官组织氧合充分性监测器的可用性，对38例危重患者（多发伤10例、烧伤5例、大手术18例和脓毒症5例）进行了粘膜内pH（pHi）测定。结果表明：（1）休克后代偿期或术后即刻pHi值降至7.3以下，但大多数病人在伤后72小时内恢复到7.3以上。2. 15例创伤休克患者伤后72 h内pHi与乳酸、IL-6、动脉酮体比、nu弹性蛋白酶、纤溶酶原激活物抑制物-1呈显著相关。肺损伤程度与pHi值有密切关系。3.尽管用Swan-Ganz导管测得的Do_2超正常值和足够的Vo_2，pHi值仍降低。传统方法不能评估患者在高动力状态下的粘膜氧合是否充分，因此，测量胃粘膜内pH值是肠系膜灌注不足发展的新预测因素。结果表明，PGE_1和多巴胺对pHi值的改善有显著的相关性，PGE_1和多巴胺对pHi值的改善有显著的相关性胃液的pH值和pH值之间的关系，因此，组胺的施用-2受体拮抗剂可能需要获得pHi的重复性。本研究结果表明，粘膜内pH的测量提供了一个衡量组织氧合是否充分的代谢指标，在术后或损伤后阶段以及在脓毒症患者中。需要进一步的研究来阐明氧如何影响组织氧合的机制。可提高粘膜化生的提取率。

To clarify an availability of gastric tonometer as a moniter for adequacy of tissue oxygenation in the splanchnic organs, intramucosal pH (pHi) was measured in 38 critically ill patients with multiple trauma (10), burn (5), major surgery (18) and sepsis (5). The results were as follows ;1.The value of pHi was reduced to less than 7.3 at the compansated state from shock or at the immediate postoperative period, but most patients recovered to the level of 7.3 or more within the first 72 hours postinjury. The pHi value in two cases persisted less than 7.3 over 72 hours postinjury with fatal outcome.2.Significant correlations were observed among pHi and lactate, IL-6, arterial keton body ratio, nutrophil elastase and plasminogen activator inhibitor-1 in 15 patients with trauma shock after the first 72 hours postinjury. A close relationship was admitted between the degree of insult and the value of pHi.3.The value of pHi was reduced despite of supranormalisation of Do2 and adequate Vo2 calculated with Swan-Ganz catheter. The adequacy of mucosal oxygenation in hyperdymamic state of patients was not assessed with the conventional method, therefore, measuring intramucosal pH in the stomach is a new predictor of development of mesenteric hypoperfusion.4.To overcome the inadequacy of tissue oxygenation, the effect of the vasodilators such as Dopamine or PGE1 were tested and the latter was effective on improving of the pHi value.5.A significant correlation was seen between pH of gastric juice and the value of pHi, therefore, the administration of a histamine-2 receptor antagonist may be required to get the reproducibility of pHi.The results of this study indicated that measurements of intramucosal pH provide a metabolic measure of the adequacy of tissue oxygenation in the postoperative or postinjury phase as well as in septic patients.Further studies are needed to eludcidate the mechanism about how oxygen extraction rate can be improved in mucosal metahbolism.