丙酮酸乙酯对脓毒性休克犬氧代谢及组织灌注指标的影响

目的 探讨丙酮酸乙酯(EP)对脓毒性休克犬组织氧合及灌注指标的影响.方法 健康雄性杂种犬20只,用脂多糖(LPS)静脉注射复制犬脓毒性休克模型,随机分为对照组(n=8)和EP组(n=12).对照组只接受林格液复苏;EP组除给予林格液复苏外加EP,首剂0.05 g/kg,然后以0.05 g·kg-1·h-1的量持续泵入.脓毒性休克模型稳定后记为0 h,此后12 h内每2 h收集组织氧合及灌注指标:氧输送(DO2)、氧消耗(VO2)、血乳酸(Lac)水平、混合静脉血氧饱和度(S vO2)、尿量、胃黏膜pH值(pHi)、胃-动脉二氧化碳分压差(Pg-aCO2).结果 脓毒性休克模型建立后,DO2、VO2、S vO2、尿量明显下降(P均＜0.05),Lac、Pg-aCO2明显上升(P均＜0.05).EP组DO2逐渐回升,8 h后与对照组比较差异仍有统计学意义(P＜0.05);VO2也有增加趋势,但与对照组比较差异无统计学意义(P＞0.05);S vO2逐渐上升,10 h后已显著超过制模前水平,且与对照组比较差异有统计学意义(P＜0.05);Lac水平逐渐下降,8 h后与对照组比较差异有统计学意义(P＜0.05);尿量在8 h后明显增加,10 h后与对照组比较差异有统计学意义(P＜0.05);pHi在6 h后明显上升,且与对照组比较差异有统计学意义(P＜0.05);Pg-aCO2在休克后8 h其升高程度较对照组低(P＜0.05).结论 EP可以改善脓毒性休克犬氧代谢及组织灌注.

Effect of ethyl pyruvate on indices of tissue oxygenation and perfusion in dogs with septic shock

OBJECTIVE: To investigate the effect of ethyl pyruvate (EP) on indices of tissue oxygenation and perfusion in dogs with septic shock. METHODS: Twenty dogs with septic shock induced by lipopolysaccharides (LPS) were randomly divided into two groups. Dog randomly received placebo (Ringer's solution; control group, n =8) or EP in lactated Ringer's solution (0.05 g/kg loading dose over 10 minutes, thereafter 0.05 g.kg(-1).h(-1) for 12 hours; EP treatment group, n =12). Indices of tissue oxygenation and perfusion were monitored every 2 hours after basic measurements (pre-LPS), including oxygen delivery (DO2), oxygen consumption (VO2), serum levels of lactate (Lac), mixed venous oxygen saturation (SvO2), urine output, intramucosal pH (pHi), gastric-to-arteria partial pressure of carbon dioxide gap (Pg-a CO2). RESULTS: DO2, VO2, SvO2 and urine output dropped significantly after septic shock (all P<0.05), but serum levels of Lac and P g-a CO2 elevated markedly (both P<0.05). DO2 increased gradually in EP group and there were significantly differences compared with control group after 8 hours (P<0.05). VO2 showed such a tendency, but there was no statistically significant intergroup difference (P>0.05). SvO2 elevated gradually in EP group, even higher than those of pre-LPS after 10 hours and there were significantly differences compared with control group (P<0.05). Serum levels of Lac decreased gradually and there was significant difference compared with control group after 8 hours (P<0.05). Urine output increased in EP group after 8 hours, and such phenomenon did not happen in control group after 10 hours (P<0.05). pHi elevated to a higher level after 6 hours, and Pg-a CO2 elevated in the treatment group, and there were significantly differences compared with control group (both P<0.05). CONCLUSION: EP infusion resulted in improved tissue oxygenation and perfusion in dogs with septic shock.