Vasoactive mediators and splanchnic perfusion

摘要: Objective To provide an overview of the splanchnic hemodynamic response to circulatory shock. Data Sources Previous studies performed in our own laboratory, as well a computerassisted search English language literature (MEDLINE, 1966 1991), followed by selective review pertinent articles. Study Selection Studies were selected that demonstrated relevance shock, either investigating pathophysiology or documenting sequelae. Article selection included clinical appropriate animal models. Extraction Pertinent data abstracted from cited Results Synthesis The shock is characterized vasoconstriction mesenteric vasculature mediated largely renin-angiotensin axis. This vasospasm, while providing natural advantage organism mild-to-moderate (preserving relative perfusion heart, kidneys, and brain), may, more severe cause consequent loss gut epithelial barrier, even hemorrhagic gastritis, ischemic colitis, hepatitis. From physiologic standpoint, nonpulsatile cardiopulmonary bypass, controlled form has been found experimentally significantly increase circulating levels angiotensin II, hormone responsible for this vasoconstriction. Conclusions While II viewed primarily mediator increased total vascular resistance seen during (and after) it may also disproportionate decrease perfusion, measured human subjects intraluminal gastric tonometry galactose clearance liver, development multiple organ failure syndrome 1% 5% patients after cardiac surgery. (Crit Care Med 1993; 21:S55-S68)