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

Research Project

Project/Area Number 05671000
Research Category

Grant-in-Aid for General Scientific Research (C)

Allocation TypeSingle-year Grants
Research Field General surgery
Research InstitutionHAMAMATSU UMIVERSITY SCHOOL OF MEDICINE

Principal Investigator

AOKI Katsunori  Hamamatsu Univ.Sch, Med.E.D.Associ.Prof., 医学部, 助教授 (20124927)

Co-Investigator(Kenkyū-buntansha) KANEKO Hiroshi  Hamamatsu Univ.Sch.Med.2nd Surg.Assis.Prof., 医学部, 助手 (10204562)
NISHINO Nobuhiko  Hamamatsu Univ.Sch, Med.2nd Surg.Assis.Prof., 医学部, 助手 (80228197)
DOI Matuyki  Hamamatsu Univ.Sch, Med.1CU Assis.Prof., 医学部, 講師 (10155616)
BABA Shozo  Hamamatsu Univ.Sch, Med.2nd Surg.Prof., 医学部, 教授 (40107818)
中井 勝彦  浜松医科大学, 医学部, 講師 (50217642)
Project Period (FY) 1993 – 1994
Project Status Completed (Fiscal Year 1994)
Budget Amount *help
¥2,200,000 (Direct Cost: ¥2,200,000)
Fiscal Year 1994: ¥1,100,000 (Direct Cost: ¥1,100,000)
Fiscal Year 1993: ¥1,100,000 (Direct Cost: ¥1,100,000)
KeywordsTonometer / mucoal pH / bacterial translocation / acidosis / critical illness / oxygen metabolism / ischemia / Do2 / 敗血症 / ショック / 多臓器障害 / 酸素 / PGE1 / ドーパミン / モニタリング / 消化管トノメーター / 外傷性ショック / 臓器障害 / 代謝亢進状態 / 組織酸素 / PGE_1
Research Abstract

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.

Report

(3 results)
  • 1994 Annual Research Report   Final Research Report Summary
  • 1993 Annual Research Report
  • Research Products

    (9 results)

All Other

All Publications (9 results)

  • [Publications] AOKI,K,NISHINO N,BABA.S,UranoT.Takada A.: "Postoperative changes in plaswa tissue-type plasminogen Activator and type 1 plasminogen Activator Inhibitor" Surgery Today. 24. 1039-1043 (1994)

    • Description
      「研究成果報告書概要(和文)」より
    • Related Report
      1994 Final Research Report Summary
  • [Publications] 馬場 正三,青木 克憲: "組織虚血の予知と酸素運搬体投与による予防" 人工血液. 3. 9-12 (1995)

    • Description
      「研究成果報告書概要(和文)」より
    • Related Report
      1994 Final Research Report Summary
  • [Publications] 馬場 正三,青木 克憲 AFM MOtin,海野直樹: "酸素化Perfluorochemical乳剤の腸管内投与による小腸の虚血・再雍流障害におけるBTの予防" 外科と代謝・栄養. (印刷中). (1995)

    • Description
      「研究成果報告書概要(和文)」より
    • Related Report
      1994 Final Research Report Summary
  • [Publications] Katsunori AOKI,Nobihiko, NISHINO,shozo BABA,Tetsumei URANO,Akikazu TAKADA.: "Postoperative Changes In Plasama tissue-Type Plasminogen Activator and type 1 Plasminogen Activator." Surgery Today. 24. 1039-1043 (1994)

    • Description
      「研究成果報告書概要(欧文)」より
    • Related Report
      1994 Final Research Report Summary
  • [Publications] Shozo BABA,Katsunori AOKI: "Monitoring of tissue hypoxia and therapeutic potential of intestinal potential of intestinal perfusion with oxygen substitutes." Artificial Blood. 3(japanese). 9-12 (1995)

    • Description
      「研究成果報告書概要(欧文)」より
    • Related Report
      1994 Final Research Report Summary
  • [Publications] "Oxygenated Perfluorochemicals Decrease the Bacterial Translocation from lschemic Gut and Prolong Survival in Rats" Japanese Journal of Surgical Metabolism and Nutrition. (in press)(japanese). (1995)

    • Description
      「研究成果報告書概要(欧文)」より
    • Related Report
      1994 Final Research Report Summary
  • [Publications] AOKI.K,Nishino N.: "Postoperative changes in ploswa Tissue-type Plasminogen Activator" Swgery Today. 24(in press). (1995)

    • Related Report
      1994 Annual Research Report
  • [Publications] 馬場正三,青木克憲: "組織虚血の予知と酸素運搬体投与による予防" 人工血液. 4. in press (1995)

    • Related Report
      1994 Annual Research Report
  • [Publications] 馬場正三,青木克憲: "酸素化PFC乳剤の腸管内投与による小腸の虚血・再灌流障害" 外科と代謝・栄養. 29(in press). (1995)

    • Related Report
      1994 Annual Research Report

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Published: 1993-04-01   Modified: 2016-04-21  

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