Document Detail

Regional blood flow distribution and oxygen metabolism during mesenteric ischemia and congestion.
MedLine Citation:
PMID:  19285689     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Acute mesenteric ischemia is a potentially fatal vascular emergency with mortality rates ranging between 60% and 80%. Several studies have extensively examined the hemodynamic and metabolic effects of superior mesenteric artery occlusion. On the other hand, the cardiocirculatory derangement and the tissue damage induced by intestinal outflow obstruction have not been investigated systematically. For these reasons we decided to assess the initial impact of venous mesenteric occlusion on intestinal blood flow distribution, and correlate these findings with other systemic and regional perfusion markers. METHODS: Fourteen mongrel dogs were subjected to 45 min of superior mesenteric artery (SMAO) or vein occlusion (SMVO), and observed for 120 min after reperfusion. Systemic hemodynamics were evaluated using Swan-Ganz and arterial catheters. Regional blood flow (ultrasonic flow probes), intestinal O(2)-derived variables, and mesenteric-arterial and tonometric-arterial pCO(2) gradients (D(mv-a)pCO(2) and D(t-a)pCO(2)) were also calculated. RESULTS: SMVO was associated with hypotension and low cardiac output. A significant increase in the regional pCO(2) gradients was also observed in both groups during the ischemic period. After reperfusion, a progressive reduction in D(mv-a)pCO(2) occurred in the SMVO group; however, no improvement in D(t-a)pCO(2) was observed. The histopathologic injury scores were 2.7 +/- 0.5 and 4.8 +/- 0.2 for SMAO and SMVO, respectively. CONCLUSIONS: SMV occlusion promoted early and significant hemodynamic and metabolic derangement at systemic and regional levels. Additionally, systemic pCO(2) gradient is not a reliable parameter to evaluate the local intestinal oxygenation. Finally, the D(t-a)pCO(2) correlates with histologic changes during intestinal congestion or ischemia. However, minor histologic changes cannot be detected using this methodology.
Ruy J Cruz; Alejandra G Garrido; Cristiane M F Ribeiro; Tomoyuki Harada; Mauricio Rocha-e-Silva
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Publication Detail:
Type:  Comparative Study; Journal Article; Research Support, Non-U.S. Gov't     Date:  2009-01-03
Journal Detail:
Title:  The Journal of surgical research     Volume:  161     ISSN:  1095-8673     ISO Abbreviation:  J. Surg. Res.     Publication Date:  2010 Jun 
Date Detail:
Created Date:  2010-05-03     Completed Date:  2010-05-20     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0376340     Medline TA:  J Surg Res     Country:  United States    
Other Details:
Languages:  eng     Pagination:  54-61     Citation Subset:  IM    
Copyright Information:
Copyright (c) 2010 Elsevier Inc. All rights reserved.
Research Division, InCor, University of S?o Paulo Medical School, S?o Paulo, Brazil.
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MeSH Terms
Hyperemia / metabolism,  pathology,  physiopathology*
Intestinal Mucosa / blood supply,  pathology,  physiopathology*
Ischemia / metabolism,  pathology,  physiopathology*
Mesentery / blood supply*
Oxygen / metabolism
Regional Blood Flow
Splanchnic Circulation*
Reg. No./Substance:

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