Palazzo M G, Suter P M
Department of Anesthesiology, University Hospital of Geneva, Switzerland.
Intensive Care Med. 1991;17(6):325-32. doi: 10.1007/BF01716190.
Delivery dependent oxygen consumption (DDOC) is observed in patients with sepsis and vital organ dysfunction, and has been related to outcome. Similarly the sick-euthyroid syndrome is associated with a high mortality. We examined the daily variations of DDOC and its relation to hormonal changes, particularly those of the thyroid. In 22 patients, 14 with septic shock and 8 post-operative controls, oxygen delivery was increased by increasing cardiac output with vasodilation by phentolamine, during a total of 207 days. DDOC varied markedly between consecutive days in individual patients with sepsis, in both survivors and non-survivors. DDOC was related to severity of illness, assessed by APACHE II score (r = 0.50, p = 0.017), and plasma levels of triiodothyronine (T3), r = -0.49, p = 0.011, and thyroxine (T4), r = -0.53, p = 0.012. No correlation was observed between DDOC and outcome, nor blood levels of lactate, epinephrine, norepinephrine, dopamine or cortisol. In conclusion, we observed a marked disturbance of systemic oxygen uptake autoregulation in patients with septic shock which varied during the clinical course and was related to the sick-euthyroid syndrome.
脓毒症和重要器官功能障碍患者存在与分娩相关的氧消耗（DDOC），且其与预后相关。同样，病态甲状腺综合征也与高死亡率相关。我们研究了DDOC的每日变化及其与激素变化的关系，特别是甲状腺激素的变化。在22例患者中，14例为感染性休克患者，8例为术后对照患者，在总共207天的时间里，通过酚妥拉明扩张血管增加心输出量来提高氧输送。在脓毒症患者个体中，无论是幸存者还是非幸存者，DDOC在连续几天之间都有显著变化。DDOC与疾病严重程度相关，通过急性生理与慢性健康状况评分系统II（APACHE II）评分评估（r = 0.50，p = 0.017），与血浆三碘甲状腺原氨酸（T3）水平相关，r = -0.49，p = 0.011，与甲状腺素（T4）水平相关，r = -0.53，p = 0.012。未观察到DDOC与预后之间的相关性，也未观察到其与血乳酸、肾上腺素、去甲肾上腺素、多巴胺或皮质醇水平之间的相关性。总之，我们观察到感染性休克患者存在明显的全身氧摄取自动调节紊乱，这种紊乱在临床过程中会发生变化，且与病态甲状腺综合征相关。
