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Tuyển tập các báo cáo nghiên cứu về y học được đăng trên tạp chí y học General Psychiatry cung cấp cho các bạn kiến thức về ngành y đề tài: Clinical review: Splanchnic ischaemia. | Critical Care August 2002 Vol 6 No 4 Jakob Review Clinical review Splanchnic ischaemia Stephan M Jakob Consultant Department of Intensive Care Medicine University Hospital Bern Switzerland Correspondence Stephan Jakob stephan.jakob@insel.ch Published online 8 April 2002 Critical Care 2002 6 306-312 This article is online at http ccforum.Com content 6 4 306 2002 BioMed Central Ltd Print ISSN 1364-8535 Online ISSN 1466-609X Abstract Inadequate splanchnic perfusion is associated with increased morbidity and mortality particularly if liver dysfunction coexists. Heart failure increased intra-abdominal pressure haemodialysis and the presence of obstructive sleep apnoea are among the multiple clinical conditions that are associated with impaired splanchnic perfusion in critically ill patients. Total liver blood flow is believed to be relatively protected when gut blood flow decreases because hepatic arterial flow increases when portal venous flow decreases the hepatic arterial buffer response HABR . However there is evidence that the HABR is diminished or even abolished during endotoxaemia and when gut blood flow becomes very low. Unfortunately no drugs are yet available that increase total hepato-splanchnic blood flow selectively and to a clinically relevant extent. The present review discusses old and new concepts of splanchnic vasoregulation from both experimental and clinical viewpoints. Recently published trials in this field are discussed. Keywords gastric mucosal pH hepatic arterial buffer response lactate splanchnic blood flow Under conditions of low systemic blood flow or haemorrhage perfusion of vital organs is maintained at the expense of perfusion of visceral organs 1-3 . If blood flow to the splanchnic tissues is sufficiently low ischaemia and if it is prolonged tissue damage and necrosis may occur. As a result of splanchnic ischaemia the gut may become permeable and endotoxin and other bacterial products can pass through the gut wall into lymph nodes and .