avaliação inicial dos gradientes sistêmicos e regionais da pco2 como marcadores de hipoperfusão mesentérica initial evaluation of systemic and regional pco2 gradients as markers of mesenteric hypoperfusion
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2006
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Abstract
RACIONAL: Apesar dos recentes avanços nos métodos de imagem e no cuidado dos doentes críticos, a taxa de mortalidade do abdome agudo vascular nas últimas duas décadas continua praticamente inalterada. OBJETIVOS: Avaliar as alterações imediatas dos gradientes regionais da pCO2 induzidas pela isquemia e reperfusão mesentérica. Determinar se outros marcadores sistêmicos de hipoperfusão esplâncnica são capazes de detectar precocemente as alterações circulatórias ocorridas na mucosa intestinal após oclusão da artéria mesentérica superior. MÉTODOS: Foram utilizados sete cães machos sem raça definida (20,6 ± 1,1 kg), submetidos a oclusão da artéria mesentérica superior por 45 minutos, sendo os animais observados por período adicional de 2 horas após a reperfusão. Variáveis hemodinâmicas sistêmicas foram avaliadas por meio de cateter arterial e Swan-Ganz. A perfusão do sistema digestório foi avaliada pela medida do fluxo sangüíneo da veia mesentérica superior e da serosa jejunal (fluxômetro ultra-sônico). Oferta, taxa de extração e consumo intestinal de oxigênio (DO2intest, TEO2intest e VO2intest, respectivamente), pH intramucoso (tonometria a gás) e os gradientes veia mesentérica-arterial e mucosa-arterial da pCO2 (Dvm-a pCO2 e Dt-a pCO2, respectivamente), foram calculados. RESULTADOS: A oclusão da artéria mesentérica superior não esteve associada a alterações hemodinâmicas sistêmicas, mas pôde-se observar aumento significativo do Dvm-a pCO2 (1,7 ± 0,5 para 5,7 ± 1,8 mm Hg) e do Dt-a pCO2 (8,2 ± 4,8 para 48,7 ± 4,6 mm Hg). Na fase de reperfusão observou-se redução da DO2intest (67,7 ± 9,9 para 38,8 ± 5,3 mL/min) e conseqüente aumento da TEO2intest de 5,0 ± 1,1% para 12,4 ± 2,7%. Não houve correlação entre os gradientes da pCO2 analisados. CONCLUSÃO: A tonometria permite detectar de maneira precoce a redução de fluxo intestinal. Além disso, pudemos demonstrar que as variações dos gradientes regionais e/ou sistêmicos da pCO2 não são capazes de avaliar a magnitude da redução de fluxo da mucosa intestinal durante o fenômeno de isquemia e reperfusão mesentérica.
BACKGROUND: Mesenteric ischemia is a life-threatening emergency with a mortality rates still ranging between 60% and 100%. AIM: To evaluate the systemic and regional pCO2 gradients changes induced by mesenteric ischemia-reperfusion injury. In addition, we sought to determine if other systemic marker of splanchnic hypoperfusion could detect the initial changes in intestinal mucosal microcirculation after superior mesenteric artery occlusion. METHODS: Seven pentobarbital anesthetized mongrel dogs (20.6 ± 1.1 kg) were subjected to superior mesenteric artery occlusion for 45 minutes, and followed for an additional 120 minutes. Systemic hemodynamic was evaluated through a Swan-Ganz and arterial catheters, while gastrointestinal tract perfusion by superior mesenteric vein and jejunal serosal blood flows (ultrasonic flowprobe). Intestinal oxygen delivery, extraction and consumption (DO2intest, ERO2intest and VO2intest, respectively), intramucosal pH (gas tonometry), and mesenteric-arterial and mucosal arterial pCO2 gradients (Dvm-a pCO2 and Dt-a pCO2, respectively) were calculated. RESULTS: Superior mesenteric artery occlusion was not associated with significant changes on systemic hemodynamics parameters. A significant increase of Dvm-a pCO2 (1.7 ± 0.5 to 5.7 ± 1.8 mm Hg) and Dt-a pCO2 (8.2 ± 4.8 to 48.7 ± 4.6 mm Hg) were detected. During the reperfusion period a significant decrease on DO2intest (67.7 ± 9.9 to 38.8 ± 5.3 mL/min) and a compensatory increase on ERO2intest from 5.0 ± 1.1% to 12.4 ± 2.7% was observed. CONCLUSION: We conclude that gas tonometry can detect the mesenteric blood flow disturbances sooner than other analyzed parameters. Additionally, we demonstrated that changes on systemic or regional pCO2 gradients are not able to detect the magnitude of intestinal mucosal blood flow reduction after mesenteric ischemia-reperfusion injury.
BACKGROUND: Mesenteric ischemia is a life-threatening emergency with a mortality rates still ranging between 60% and 100%. AIM: To evaluate the systemic and regional pCO2 gradients changes induced by mesenteric ischemia-reperfusion injury. In addition, we sought to determine if other systemic marker of splanchnic hypoperfusion could detect the initial changes in intestinal mucosal microcirculation after superior mesenteric artery occlusion. METHODS: Seven pentobarbital anesthetized mongrel dogs (20.6 ± 1.1 kg) were subjected to superior mesenteric artery occlusion for 45 minutes, and followed for an additional 120 minutes. Systemic hemodynamic was evaluated through a Swan-Ganz and arterial catheters, while gastrointestinal tract perfusion by superior mesenteric vein and jejunal serosal blood flows (ultrasonic flowprobe). Intestinal oxygen delivery, extraction and consumption (DO2intest, ERO2intest and VO2intest, respectively), intramucosal pH (gas tonometry), and mesenteric-arterial and mucosal arterial pCO2 gradients (Dvm-a pCO2 and Dt-a pCO2, respectively) were calculated. RESULTS: Superior mesenteric artery occlusion was not associated with significant changes on systemic hemodynamics parameters. A significant increase of Dvm-a pCO2 (1.7 ± 0.5 to 5.7 ± 1.8 mm Hg) and Dt-a pCO2 (8.2 ± 4.8 to 48.7 ± 4.6 mm Hg) were detected. During the reperfusion period a significant decrease on DO2intest (67.7 ± 9.9 to 38.8 ± 5.3 mL/min) and a compensatory increase on ERO2intest from 5.0 ± 1.1% to 12.4 ± 2.7% was observed. CONCLUSION: We conclude that gas tonometry can detect the mesenteric blood flow disturbances sooner than other analyzed parameters. Additionally, we demonstrated that changes on systemic or regional pCO2 gradients are not able to detect the magnitude of intestinal mucosal blood flow reduction after mesenteric ischemia-reperfusion injury.
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jr.2006arquivosavaliao
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| Authors | ;Ruy J. Cruz Jr.;Cristiano J. Correia;Luiz F. Poli-de-Figueiredo;Mauricio Rocha-e-Silva |
| Journal | journal of heterocyclic chemistry |
| Year | 2006 |
| DOI |
10.1590/S0004-28032006000100015
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