Spezifische Parameter im Blut und Bauchpunktat zur Ermittlung des Schweregrades von intestinaler Ischämie bei Kolikpferden

A. Grosche; W. Schrödl; G. F. Schusser

doi:10.1055/s-0037-1621094

Tierärztliche Praxis Ausgabe G: Großtiere / Nutztiere, Table of Contents

Tierarztl Prax Ausg G Grosstiere Nutztiere 2006; 34(06): 387-396
DOI: 10.1055/s-0037-1621094

Pferd

Schattauer GmbH

Spezifische Parameter im Blut und Bauchpunktat zur Ermittlung des Schweregrades von intestinaler Ischämie bei Kolikpferden

Specific parameters of blood and peritoneal fluid to indicate the severity of intestinal ischemia in colic horses

A. Grosche

¹Aus der Medizinischen Tierklinik (Direktor: Prof. Dr. Dipl. ECEIM G. F. Schusser)

,

W. Schrödl

²und dem Institut für Bakteriologie und Mykologie (Direktor: Prof. Dr. M. Krüger), Veterinärmedizinische Fakultät der Universität Leipzig

,

G. F. Schusser

¹Aus der Medizinischen Tierklinik (Direktor: Prof. Dr. Dipl. ECEIM G. F. Schusser)

› Author Affiliations

Abstract

Zusammenfassung:

Ziel: Zur Beurteilung von intestinaler Ischämie wurden spezifische Parameter im Blut und Bauchpunktat (BP) bei Pferden mit verschiedenen Kolikformen untersucht. Material und Methoden: Bei acht gesunden und 26 Kolikpferden (Dislocatio coli [geringgradige Ischämie], n = 14; Dünndarmstrangulation [hochgradige Ischämie], n = 12) erfolgte im Blut und/oder BP die Bestimmung folgender Parameter: Leukozytenzahl, Hämatokrit (HK), pH-Wert, Basenüberschuss, Harnstoff, Kreatinin,Totalprotein (TP), Albumin, Laktat, LDH, AP, CK und C-reaktives Protein (CRP). Für TP, Albumin, Laktat, LDH, AP, CK, CRP wurde das Verhältnis der Werte in BP und Blut (BP/B-Ratio) berechnet und mit den Light-Kriterien zum Nachweis eines Exsudatsverglichen. Eine Differenzierung und Beurteilung der Leukozyten im BP nach spezifischen Apoptose- und Ne- krosemerkmalen erfolgte an gefärbten Ausstrichen. Die Statistik beinhaltete u. a. die Prüfung auf Zuverlässigkeit der Light-Kriterien und die Berechnung der Korrelationen der Parameter zum Ischämiegrad. Ergebnisse: Mit zunehmendem Schweregrad der Kolik ergab sich eine signifikante Erhöhung und positive Korrelation von Laktat, LDH und CK im Blut sowie von TP, Albumin, Laktat, LDH, AP, CK und CRP im BP. Auch die BP/B-Ratio dieser Parameter korrelierte signifikant mit dem Ischämiegrad. Nur bei Pferden mit Dünndarmstrangulation entsprach das BP bezüglich der Light-Kriterien einem Exsudat. Die Wahrscheinlichkeit, dass ein BP ein Exsudat darstellte, war bei einer LDH-Aktivität von > 200 U/l am größten. Die CRP-Konzentration im BP stieg bei Pferden mit hochgradiger Ischämie signifikantan. Die Leukozytenbeurteilung ergab bei allen Kolikpferden einen erhöhten prozentualen Anteil apoptotischer Zellen, v. a. polymorphkerniger Zellen, und eine signifikante Zunahme nekrotischer Leukozyten im BP bei Pferden mit Dünndarmstrangulation. Schlussfolgerung und klinische Relevanz: TP, Albumin, Laktat, LDH, AP, CK im BP und die BP/B-Ratio dieser Parameter sind für die Beurteilung ischämischer Prozesse hilfreich. CRP im BP und die Light-Kriterien können zur Charakterisierung hochgradiger intestinaler Schädigungen genutzt werden. Eine gesteigerte Apoptose und Nekrose der Leukozyten im BP stellen Indikatoren für intraabdominale Entzündungen dar.

Summary:

Objective: Specific parameters of blood and peritoneal fluid of horses with different types of colic were evaluated to indicate the degree of intestinal ischemia. Material and methods: Following physical examination of eight healthy and 26 colic horses (14 with large colon displacement [mild ischemia], 12 with small intestinal strangulating obstruction [severe ischemia]) blood and peritoneal fluid (PF) samples were taken to analyze WBC, PCV, pH, base excess, urea, creatinine, total protein (TP), albumin, lactate, LDH, AP, CK, and C-reactive protein (CRP). Furthermore, the ratio of PF and blood values (PF/B ratio) of TP, albumin, lactate, LDH, AP, CK, CRP was calculated to distinguish PF into transudate or exudate according to the Light's criteria. Differentiation of leukocytes of stained PF smears, and the classification into morphological normal, apoptotic and necrotic cells was performed. Statistical analysis included the verification of the reliability of Light's criteria and the calculation of the correlation of parameters and the severity of ischemia. Results: In all colic horses activities of blood lactate, LDH, CK as well as TP, albumin, lactate, LDH, AP, CK and CRP of PF were significantly increased and positively correlated depending on the severity of colic. The PF/B ratio of these parameters also had a correlation to the degree of ischemia. Regarding the Light's criteria only PF of horses with small intestinal strangulating obstruction represented an exudate. The probability of PF to be an exudate was greatest if LDH activity exceeded 200 U/l. CRP was significantly increased in PF of horses with severe ischemia. The percentage of apoptotic cells, especially of PMN was increased in all colic horses. Only horses with small intestinal strangulating obstruction had a significantly increased percentage of necrotic cells. Clinical relevance and conclusions: The values of TP, albumin, lactate, LDH, AP, CK of PF, as well as the PF/B ratio of these parameters are helpful to evaluate ischemic injuries. An increased CRP of PF as well as the Light's criteria can be used to detect severe intestinal injuries. An increased percentage of PF leukocyte apoptosisand necrosis indicates abdominal inflammatory processes.

Schlüsselwörter:

Exsudat - Light-Kriterien - LDH - CK - C-reaktives Protein - Apoptose - Nekrose

Key words:

Exudate - Light's criteria - LDH - CK - C-reactive protein - apoptosis - necrosis

Full Text

References

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