Steele L, Webster N R
University of Aberdeen, Aberdeen, U.K.
J R Coll Surg Edinb. 2001 Feb;46(1):29-34.
An understanding of the normal functioning of the heart and how it fails is important since it allows rational treatment. Pre-existing cardiac disease and myocardial dysfunction is common in the surgical patient. Moreover, the stress response of surgery and the alterations in body physiology seen in the post-operative period may further aggrivate any cardiac compromise. The end result may be a patient who has cold peripheries due to vasoconstriction and hypoperfusion with dyspnoea due to congested lungs and a heart that cannot function adequately. The postoperative patient is at risk of these changes because of the stress response, analgesic therapy, inappropriate fluid management, hypoxia and previous cardiac compromise. The patient with sepsis is at further risk because of alterations in both systolic and diastolic function, which may be the result of inadequate fluid resuscitation and also release of a variety of inflammatory mediators. Until treatments, which are aimed at correcting the effects of these mediators, are proven to be beneficial then the septic patient will continue to be managed according to the physiological principles as outlined by Starling.
了解心脏的正常功能及其衰竭机制很重要，因为这有助于进行合理治疗。手术患者中，既往存在的心脏病和心肌功能障碍很常见。此外，手术的应激反应以及术后出现的身体生理变化可能会进一步加重任何心脏损害。最终结果可能是患者因血管收缩和灌注不足而出现外周发冷，因肺部充血和心脏功能无法充分发挥而出现呼吸困难。术后患者由于应激反应、镇痛治疗、液体管理不当、缺氧以及既往心脏损害而面临这些变化的风险。脓毒症患者由于收缩和舒张功能的改变而面临更大风险，这可能是液体复苏不足以及多种炎症介质释放的结果。在旨在纠正这些介质作用的治疗被证明有益之前，脓毒症患者将继续按照 Starling 概述的生理原则进行管理。
