Hyperlactat�mie bei Darmisch�mie

Abstract

Looking for an early laboratory parameter in diagnosis of acute bowel ischemia, we caused an acute ischemia of the rabbit bowel by clamping the superior mesenteric artery. The blood tests showed a significant increase of lactate during 80 min of ischemia. This lactate excess continued nearly 40 min after revascularization of the bowel, but disappeared nearly completely after 90 min. Neither the laparotomy without clamping the superior mesenteric artery, nor the experimental clamping of the a. femoralis communis led to a lactacidemia. The lactacidemia in our experiments is compared with clinical observations in acute bowel diseases and vascular surgery with clamping of the aorta. The reasons of the specific high lactate excess of bowel ischemia are discussed. The fast increase of the lactate following mesenteric vascular occlusion and the rapid normalisation of lactate after recovery demonstrate a sensitive method in the diagnosis and controlling the treatment of acute bowel diseases with an insufficient blood supply.

Beyond Lactate: Is There a Role for Serum Lactate Measurement in Diagnosing Acute Mesenteric Ischemia?

“…Nutz et al [27] performed a study in which they cross-clamped the superior mesenteric artery in rabbits, and they noted increased serum lactate until about 40 min after revascularization of the bowel, which was absent after cross-clamping of the common femoral artery. Similar observations were made after occlusion of the superior mesenteric artery as opposed to, for example, clamping of celiac vessels [28,29].…”

Role of Serum Lactic Acid Level in Diagnosing Mesenteric Bowel Ischemia With the Aid of the Ct Angiogram.

“…(16) These kinds of studies continue during the 21 st century where some studies confirmed the relation and others didn't confirm the relation. (17,18) Several experimental studies were conduct with debatable findings and without providing conclusive evidences of the efficacy of using serum lactate level as marker for AMI, in study on rabbits by Nutz et al , the authors observed increasing in the level of serum lactate among the subjects with occlusion of the superior mesenteric artery , these results couldn't be confirmed in 1995 study on pigs conducted by Schlichting and Lyberg, (19,20) In addition to that several experimental studies during the first decade of 21 st century concluded that serum lactate level is not a specific and early diagnostic marker for AMI. (13,21,22) Several prospective clinical studies on lactate levels andacute mesenteric ischemia were conduct , from these studies the two studies conduct 1994 and 1997 by Lange and Jackel and also Lange and Toivola where the authors concluded that even with the high sensitivity of serum lactate the specificity was low which mean that doctors couldn't rely on serum lactate as specific markers.…”