Service de Réanimation, Hôpital Ambroise Paré, Assistance Publique des Hôpitaux de Paris, 9 avenue Charles de Gaulle, 92104 Boulogne, France.
Ann Intensive Care. 2011 Apr 13;1(1):6. doi: 10.1186/2110-5820-1-6.
Depression of left ventricular (LV) intrinsic contractility is constant in patients with septic shock. Because most parameters of cardiac function are strongly dependent on afterload, especially in this context, the cardiac performance evaluated at the bedside reflects intrinsic contractility, but also the degree of vasoplegia. Recent advances in echocardiography have allowed better characterization of septic cardiomyopathy. It is always reversible providing the patient's recovery. Unlike classic cardiomyopathy, it is not associated with high filling pressures, for two reasons: improvement in LV compliance and associated right ventricular dysfunction. Although, it is unclear to which extent it affects prognosis, a hyperkinetic state is indicative of a profound and persistent vasoplegia associated with a high mortality rate. Preliminary data suggest that the hemodynamic response to a dobutamine challenge has a prognostic value, but large studies are required to establish whether inotropic drugs should be used to treat this septic cardiac dysfunction.
左心室（LV）固有收缩力抑制在感染性休克患者中是持续存在的。由于心脏功能的大多数参数强烈依赖于后负荷，尤其是在这种情况下，床边评估的心脏功能反映了固有收缩力，但也反映了血管麻痹的程度。超声心动图的最新进展使得更好地描述感染性心肌病成为可能。它总是可以逆转，只要患者恢复。与经典心肌病不同，它不伴有高充盈压，原因有二：LV 顺应性改善和相关右心室功能障碍。尽管它对预后的影响程度尚不清楚，但高动力状态表明存在严重且持续的血管麻痹，与高死亡率相关。初步数据表明，多巴酚丁胺挑战的血流动力学反应具有预后价值，但需要进行大型研究以确定是否应该使用正性肌力药物来治疗这种感染性心脏功能障碍。
