A study of splanchnic circulation and gastrointestinal mucosal function in critically ill patients.

为探讨内毒素血症与内脏循环的关系，对29例接受低温体外循环（CPB）心脏手术的成人患者，（ETXa、ETXhv）、血液血管紧张素-2水平、动脉和肝静脉血氧饱和度术中、术后分别测定SvO 2、ShvO 2、动、肝静脉血酮体比值（AKBR、HVKBR）及胃粘膜pH（pHi）。手术期间血清内毒素水平在正常范围内（<10 pg/ml），术后第1天（POD 1）和第2天（POD 2）血清内毒素水平升高。ETXa和ETXhv之间无显著差异。血管紧张素-2水平在CPB期间升高，手术后迅速下降。AKBR和HVKBR在CPB期间显著降低，术后升高，与KBR的变化呈交互变化。SvO 2和ShvO 2在CPB开始后立即升高，在CPB复温阶段下降，ShvO 2显著降低。结果表明，在使用冷CPB的心脏手术期间，肝-内脏循环恶化。POD 1和POD 2时血液内毒素水平的升高可能是由于内脏循环恢复后从胃肠器官中洗脱出来所致。

To determine the relationship between endotoxemia and splanchnic circulation in 29 adult patients who underwent heart surgery using hypothermic cardiopulmonary bypass (CPB), arterial and venous endotoxin levels (ETXa, ETXhv), bood angiotensin-2 level, arterial and hepatic venous blood oxygen saturations (SvO2, ShvO2), arterial and hepatic venous blood ketone body ratios (AKBR, HVKBR) and gastric intramucosal pH (pHi) were measured during and after surgery. Serum level of endotoxin levels were within a normal range (<10pg/ml) during surgery, and increased at the first post operative day (POD1) and the second post operative day (POD2). There was no significant difference between ETXa and ETXhv. Angiotensin-2 level increased during CPB and rapidly decreased after surgery. AKBR and HVKBR significantly decreased during CPB, and increased after surgery showing reciprocal change with the changes in KBRs. SvO2 and ShvO2 increased immediately after the initiation of CPB and decreased at the rewarming stage of CPB showing significant decrease in ShvO2. Results suggest that hepato-splanchnic circulation is deteriorated during cardiac surgery using cold CPB. The increase in blood endotoxin levels at POD1 and POD2 might be due to the wash-out from gastrointestinal organs after recovery of splanchnic circulation.