Intramucosal pH measurement with tonometers for detecting gastrointestinal ischemia in critically ill patients
Grant-in-Aid for General Scientific Research (C)
|Allocation Type||Single-year Grants|
|Research Institution||HAMAMATSU UMIVERSITY SCHOOL OF MEDICINE|
AOKI Katsunori Hamamatsu Univ.Sch, Med.E.D.Associ.Prof., 医学部, 助教授 (20124927)
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
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)
|Keywords||Tonometer / 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|
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.
Research Output (9results)