Vincent J L, Gris P, Coffernils M, Leon M, Pinsky M, Reuse C, Kahn R J
Department of Intensive Care, Erasme University Hospital, Free University of Brussels, Belgium.
Surgery. 1992 Jun;111(6):660-7.
The relationship between cardiac and vascular abnormalities was studied in 68 patients with established septic shock. At time of hemodynamic evaluation, after initial resuscitation, there was no significant difference in arterial pressure, pulmonary artery pressure, cardiac filling pressures, and cardiac index between the 38 survivors of shock and the 30 patients who died of shock, but the left ventricular stroke work index and the right ventricular (RV) stroke work index were higher in survivors than in those who died (mean +/- SD: 25.0 +/- 9.1 vs 20.1 +/- 9.4 gm/m2 [p less than 0.05] and 6.6 +/- 3.6 vs 4.8 +/- 2.8 gm/m2 [p less than 0.05], respectively). Survivors had also higher thermodilution RV ejection fraction and lower RV end-diastolic volumes than had those who died (43.9% +/- 16.3% vs 31.1% +/- 13.7% [p less than 0.01] and 82 +/- 30 vs 99 +/- 31 ml/m2 [p less than 0.05], respectively). Calculated systemic vascular resistance was similar in the two groups, but vasopressors had been required in 22 (58%) of 38 survivors and 25 (83%) of 30 patients who died (p less than 0.01). Moreover, when the patients were separated into two groups according to their cardiac output, higher or lower than 3 L/min/m2, in both subgroups patients who died had lower blood pressure than had survivors. Blood lactate levels were significantly lower in survivors than in nonsurvivors (5.1 +/- 2.1 vs 8.1 +/- 4.7 mEq/L, p less than 0.01). Final data obtained before recovery of shock or death indicated that the survivors had higher arterial pressure, lower pulmonary artery pressure and right atrial pressure, higher stroke volume, and higher RV ejection fraction than had the patients who died. No survivors but all patients who died had been treated with vasopressors. These data therefore indicate that death as a result of septic shock is characterized by both myocardial depression and altered vascular tone and both are probably interrelated.
对68例确诊为感染性休克的患者的心脏和血管异常之间的关系进行了研究。在血流动力学评估时，初始复苏后，休克存活的38例患者与死于休克的30例患者在动脉压、肺动脉压、心脏充盈压和心脏指数方面无显著差异，但存活者的左心室每搏功指数和右心室（RV）每搏功指数高于死亡者（均值±标准差：分别为25.0±9.1 vs 20.1±9.4 g·m²[p<0.05]和6.6±3.6 vs 4.8±2.8 g·m²[p<0.05]）。存活者的热稀释法右心室射血分数也高于死亡者，右心室舒张末期容积低于死亡者（分别为43.9%±16.3% vs 31.1%±13.7%[p<0.01]和82±30 vs 99±31 ml/m²[p<0.05]）。两组计算所得的全身血管阻力相似，但38例存活者中有22例（58%）、30例死亡患者中有25例（83%）需要使用血管升压药（p<0.01）。此外，当根据心输出量将患者分为两组，高于或低于3 L/min/m²时，在两个亚组中，死亡患者的血压均低于存活者。存活者的血乳酸水平显著低于非存活者（5.1±2.1 vs 8.1±4.7 mEq/L，p<0.01）。在休克恢复或死亡前获得的最终数据表明，存活者的动脉压较高、肺动脉压和右心房压较低、每搏量较高以及右心室射血分数较高，而死亡患者均接受了血管升压药治疗。因此，这些数据表明，感染性休克导致的死亡具有心肌抑制和血管张力改变的特征，且两者可能相互关联。
