Ahrens Tom
Nursing Service, Barnes-Jewish Hospital, MS 90-59-360, St Louis, MO 63110, USA.
AACN Adv Crit Care. 2006 Oct-Dec;17(4):435-45. doi: 10.4037/15597768-2006-4008.
Hemodynamics in sepsis change as sepsis develops. Initial hemodynamics of sepsis often are much different from later stages of sepsis, shifting from low cardiac output states to high cardiac output states. Tissue oxygenation also changes with initial mixed venous oxyhemoglobin (Svo2) or central venous oxyhemoglobin (Scvo2) levels below normal, with later stages reflecting high values. These changes occur as sepsis progresses, producing a marked disturbance in capillary flow and tissue oxygenation. Treatments for these changes in sepsis are different, making the identification of the hemodynamic state essential to optimally treat the patient. Fortunately, hemodynamic monitoring techniques are markedly improved from older techniques such as the pulmonary artery catheter. With noninvasive techniques such as esophageal and external Doppler for measuring hemodynamics, clinicians beyond the intensive care unit can make hemodynamic assessments that were not possible until just recently. This improved assessment should make it much easier to properly identify sepsis and initiate appropriate treatments in a timely manner.
脓毒症时的血流动力学随脓毒症的发展而变化。脓毒症早期的血流动力学通常与后期有很大不同，从低心输出量状态转变为高心输出量状态。组织氧合也会发生变化，最初混合静脉血氧血红蛋白（Svo2）或中心静脉血氧血红蛋白（Scvo2）水平低于正常，后期则反映为高值。随着脓毒症的进展会出现这些变化，从而在毛细血管血流和组织氧合方面产生显著紊乱。针对脓毒症这些变化的治疗方法有所不同，因此确定血流动力学状态对于最佳治疗患者至关重要。幸运的是，与诸如肺动脉导管等较旧技术相比，血流动力学监测技术有了显著改进。借助诸如食管和外部多普勒等无创技术来测量血流动力学，重症监护病房以外的临床医生也能够进行血流动力学评估，而这在不久前还是无法做到的。这种改进的评估应会使正确识别脓毒症并及时启动适当治疗变得容易得多。
