Spronk Peter E, Zandstra Durk F, Ince Can
Department of Intensive Care Medicine, Gelre ziekenhuizen, Apeldoorn, The Netherlands.
Crit Care. 2004 Dec;8(6):462-8. doi: 10.1186/cc2894. Epub 2004 Jun 16.
Microcirculatory perfusion is disturbed in sepsis. Recent research has shown that maintaining systemic blood pressure is associated with inadequate perfusion of the microcirculation in sepsis. Microcirculatory perfusion is regulated by an intricate interplay of many neuroendocrine and paracrine pathways, which makes blood flow though this microvascular network a heterogeneous process. Owing to an increased microcirculatory resistance, a maldistribution of blood flow occurs with a decreased systemic vascular resistance due to shunting phenomena. Therapy in shock is aimed at the optimization of cardiac function, arterial hemoglobin saturation and tissue perfusion. This will mean the correction of hypovolemia and the restoration of an evenly distributed microcirculatory flow and adequate oxygen transport. A practical clinical score for the definition of shock is proposed and a novel technique for bedside visualization of the capillary network is discussed, including its possible implications for the treatment of septic shock patients with vasodilators to open the microcirculation.
脓毒症时微循环灌注会受到干扰。近期研究表明，在脓毒症中维持全身血压与微循环灌注不足有关。微循环灌注受许多神经内分泌和旁分泌途径的复杂相互作用调节，这使得流经该微血管网络的血流成为一个不均匀的过程。由于微循环阻力增加，因分流现象导致全身血管阻力降低时会出现血流分布不均。休克治疗旨在优化心脏功能、动脉血红蛋白饱和度和组织灌注。这将意味着纠正血容量不足，并恢复均匀分布的微循环血流和充足的氧输送。本文提出了一种用于定义休克的实用临床评分方法，并讨论了一种用于床旁可视化毛细血管网络的新技术，包括其对使用血管扩张剂治疗脓毒性休克患者以开放微循环的可能影响。
