Boerma E C, van der Voort P H J, Ince C
Department of Physiology, Academic Medical Centre, University of Amsterdam, the Netherlands.
Acta Anaesthesiol Scand. 2005 Oct;49(9):1387-90. doi: 10.1111/j.1399-6576.2005.00752.x.
For many decades arterial blood pressure regulation has been an important issue in the treatment of septic shock. The pathogenesis of this persistent hypotension is complex and multifactorial, but inability of vascular smooth muscle to contract in the presence of vasoconstrictive agents seems to be a key factor. Many mechanisms have been proposed to account for this failure, including nitric oxide (NO) overproduction and vasopressin deficiency (1). However, improvement of outcome due to intervention in these mechanisms fails to be reported despite the restoration of blood pressure. Recent studies of the microcirculation in humans by means of orthogonal polarization spectral (OPS) imaging have opened challenging new perspectives to study the microcirculation (2, 3). We report a case in which sublingual OPS imaging was performed upon administration of terlipressin in a patient with catecholamine-resistant septic shock. It indicates that much caution should be taken when considering such potent vasoconstrictor when correcting blood pressure during shock.
几十年来，动脉血压调节一直是脓毒性休克治疗中的一个重要问题。这种持续性低血压的发病机制复杂且多因素，但在血管收缩剂存在的情况下血管平滑肌无法收缩似乎是一个关键因素。已经提出了许多机制来解释这种失败，包括一氧化氮（NO）产生过多和血管加压素缺乏（1）。然而，尽管血压恢复，但尚未有关于通过干预这些机制改善预后的报道。最近通过正交偏振光谱（OPS）成像对人体微循环进行的研究为研究微循环开辟了具有挑战性的新视角（2,3）。我们报告了一例在使用特利加压素治疗对儿茶酚胺耐药的脓毒性休克患者时进行舌下OPS成像的病例。这表明在休克期间纠正血压时考虑使用这种强效血管收缩剂时应格外谨慎。
