Lungrekrytering (korta kraftfulla ökningar av luftvägstrycket) är ett modernt alternativ för att öppna sammanfallen lungvävnad under respiratorbehandling av patienter med akut lungskada. Det är väl känt att respiratorbehandling med övertrycksventilation påverkar systemcirkulationen negativt, och att effekterna på regionala kärlbäddar kan vara mer uttalade än de systemcirkulatoriska effekterna.
Minskat blodflöde till bukorganen kan leda till syrebrist i tarmvävnad och vävnadsskador med åtföljande lokal inflammation. En sådan lokal inflammation har sammankopplats med utvecklingen av multipelt organ dysfunktions-syndrom, ett syndrom med hög mortalitet som fortfarande är en ledande dödsorsak inom intensivvården. Målsättningen med detta avhandlingsarbete har därför varit att undersöka om lungrekrytering orsakar skadliga effekter på tarmens cirkulation, syrsättning eller metabolism och i vilken utsträckning en sådan negativ påverkan kan minskas (med farmakologiska eller prekonditionerande interventioner).
I vårt första delarbete studerades intensivvårdade patienter under respirator-behandling, och magsäckens blodflöde mättes under lungrekrytering. Vi fann en trend av gradvis minskande blodflöde i magsäcken. I vårt fortsatta experimentella arbete ville vi mer noggrant kartlägga tarmens svar på lungrekrytering vid respiratorbehandling av akut lungskada. Delarbete två beskriver en experimentell djurmodell (gris) där sövda djur orsakas akut lungskada med intravenös infusion av oljesyra. Vi beskriver i detta arbete först fördelningen till olika organ av intravenöst given 3H märkt oljesyra, och konkluderar att majoriteten av oljesyran kan återfinnas i lunga, men att små mängder även distribueras till tarmen. I detta arbete visar vi också att tarmens regionala cirkulation, syrsättning och metabolism återgår till baslinje förhållanden 90 minuter efter avslutad oljesyra infusion. I tredje delarbetet studerades effekterna av lungrekrytering i ovan beskrivna modell.
Huvudfynden i delarbete tre är att lungrekrytering orsakar en kortvarig och övergående påverkan på tarmens syrsättning och metabolism. I detta arbete undersöktes också om en intravenös infusion av ett kärlvidgande ämne, prostaglandin I2, kunde modulera effekterna av lungrekrytering. Resultaten talar för att effekterna av prostaglandin I2 är små och ej entydigt positiva. I vårt fjärde och sista delarbete studerades om den kraftiga system och regional cirkulatoriska påverkan som ses under lungrekrytering kan utlösa ett ischemiskt prekonditioneringsvar i tunntarm. Sövda lungfriska djur (gris) exponerades dels för lungrekrytering, och dels för klassisk ischemisk prekonditionering (temporär avstängning av arteria mesenterica superior), och jämfördes sedan med en kontrollgrupp. Vi fann i delarbete fyra att varken lungrekrytering eller klassisk ischemisk prekonditionering utlöste något skyddande svar i grisens tunntarm.
Vi konkluderar att lungrekrytering ur tarmens synpunkt förefaller säkert, och att behandling med kärlvidgande läkemedel samtidigt med lungrekrytering inte är entydigt gynnsamt.
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