Dokument: Einfluss einer milden Hypothermie auf die Mikrozirkulation der Magenschleimhaut während systemischer Hypoxie
| Titel: | Einfluss einer milden Hypothermie auf die Mikrozirkulation der Magenschleimhaut während systemischer Hypoxie | |||||||
| Weiterer Titel: | Effects of mild hypothermia on gastric microcirculation during systemic hypoxia | |||||||
| URL für Lesezeichen: | https://docserv.uni-duesseldorf.de/servlets/DocumentServlet?id=31384 | |||||||
| URN (NBN): | urn:nbn:de:hbz:061-20141124-114745-3 | |||||||
| Kollektion: | Dissertationen | |||||||
| Sprache: | Deutsch | |||||||
| Dokumententyp: | Wissenschaftliche Abschlussarbeiten » Dissertation | |||||||
| Medientyp: | Text | |||||||
| Autor: | Weiß, Susanne [Autor] | |||||||
| Dateien: |
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| Beitragende: | Prof. Dr. Picker, Olaf [Betreuer/Doktorvater] Prof. Dr. May, Petra [Gutachter] | |||||||
| Stichwörter: | Hypothermie, Hypoxie, Gastrointestinaltrakt, Mikrozirkulation, Mikrovaskuläre Hämoglobinoxygenierung, Mikrovaskulärer Blutfluss, Reflexionsspektrometrie, Laserdopplerflussmessung, Levosimendan, Glibenclamid | |||||||
| Dewey Dezimal-Klassifikation: | 600 Technik, Medizin, angewandte Wissenschaften » 610 Medizin und Gesundheit | |||||||
| Beschreibung: | Zusammenfassung
Einfluss einer milden Hypothermie auf die Mikrozirkulation der Magenschleimhaut während systemischer Hypoxie Fragestellungen und Ziele: Die gastrointestinale Schleimhaut bildet eine effektive Barriere gegen die Translokation von im Darmlumen enthaltenen Bakterien und deren Toxinen in das Blut und in das lymphatische System. Eine Beeinträchtigung dieser Barrierefunktion begünstigt durch den Übertritt der Bakterien und Endotoxine den Beginn einer systemischen Inflammationsreaktion mit verschiedensten Komplikationen. Hypoxische Situationen treten in der Intensivmedizin aus unterschiedlichen Gründen auf und können über eine reduzierte Oxygenierung die Barrierefunktion der gastrointestinalen Schleimhaut herabsetzen. Milde Hypothermie wird bereits erfolgreich in einigen klinischen Bereichen zur Verbesserung und Erhaltung verschiedener Gewebefunktionen während und nach hypoxischen Ereignissen angewandt. Sie zeigte auch bereits positive Wirkungen auf die mikrovaskuläre Oxygenierung der gastrointestinalen Schleimhaut während eines hämorrhagischen Schocks. Zu klären war nun, ob Hypothermie auch eine positive Wirkung auf die mikrovaskuläre Hämoglobinoxygenierung (µHbO2) unter physiologischen Bedingungen und unter zusätzlicher systemischer Hypoxie hat. Da sowohl die Hypothermie als auch die Hypoxie über eine Kalziumdesensibiliserung des Myokards und durch eine Änderung des Gefäßtonus über vaskuläre K+-ATP-Kanäle das Herzzeitvolumen verringern, sollte weiterhin geklärt werden, ob der K+-ATP-Kanalantagonist Glibenclamid oder der K+-ATP-Kanalagonist und Kalziumsensitizer Levosimendan über eine K+-ATP-Kanal- Modulation oder über eine Kalziumsensibilisierung die µHbO2 beeinflussen. Methodik: Die Effekte einer milden Hypothermie (34 °C) auf die µHbO2 wurden zunächst unter physiologischen Bedingungen und danach unter zusätzlicher Hypoxie (FiO2 = 0,12 für 15 Minuten) in wiederholten Versuchen an fünf gesunden, weiblichen Foxhounds in Allgemeinanästhesie mit Sevofluran untersucht. Zum Vergleich dienten Versuche unter Normothermie (37,5 °C). Weiterhin wurden in zusätzlichen Versuchen unter Hypothermie Glibenclamid (0,2 mg ∙ kg-1 über 10 Minuten) bzw. Levosimendan (20 µg ∙ kg-1 über 15 Minuten, gefolgt von einer kontinuierlichen Infusion von 0,25 µg ∙ kg-1 ∙ min-1) vor Beginn der hypoxischen Phase appliziert. Dabei wurden in allen Versuchen die systemischen Kreislaufparameter, die gastrale und orale µHbO2 mittels Reflexionsspektrophotometrie und der mikrovaskuläre Blutfluss mittels Laserdopplerflussmessung kontinuierlich aufgezeichnet und regelmäßig Blutgasanalysen durchgeführt. Ergebnisse und Schlussfolgerungen: Unter physiologischen Bedingungen steigerte eine milde Hypothermie die Oxygenierung der oralen Schleimhaut während die der Magenschleimhaut unverändert blieb. Unter Anwendung von milder Hypothermie sind die Auswirkungen einer zusätzlichen Hypoxie auf die orale und gastrale Mikrozirkulation abschwächt und die Hypothermie wirkt somit potentiell protektiv auf die Schleimhaut. Zur Verringerung der hypothermiebedingten kardiodepressiven Wirkungen eignete sich Levosimendan über eine kalziumsensibilisierende Wirkung. Da weder der K+-ATP-Kanalantagonist Glibenclamid, noch der K+-ATP-Kanalagonist und Kalziumsensitizer Levosimendan zu lokalen Veränderungen der gastrointestinalen µHbO2 geführt haben, scheinen weder vaskuläre K+-ATP-Kanäle noch eine lokale Kalziumdesensibilisierung im Splanchnikusgebiet an der Regulation der gastrointestinalen Mikrozirkulation unter Hypoxie und Hypothermie beteiligt zu sein. | |||||||
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| Lizenz: |  Urheberrechtsschutz | |||||||
| Bezug: | Februar 2011 bis Oktober 2014 | |||||||
| Fachbereich / Einrichtung: | Medizinische Fakultät | |||||||
| Dokument erstellt am: | 24.11.2014 | |||||||
| Dateien geändert am: | 24.11.2014 | |||||||
| Promotionsantrag am: | 11.11.2013 | |||||||
| Datum der Promotion: | 29.10.2014 |
