Department of Intensive Care, Erasmus Medical Center, University Medical Center, Rotterdam, The Netherlands.
Semin Respir Crit Care Med. 2011 Oct;32(5):558-68. doi: 10.1055/s-0031-1287864. Epub 2011 Oct 11.
Largely ignored throughout the history of clinical medicine, the microcirculation has recently been recognized at the bedside as the center of several pathophysiological processes. Normal microcirculatory function is critical for adequate tissue oxygenation and organ function, but it has a poorly understood and highly heterogeneous structure that is related to the diversity of functions that it accomplishes. The most important function of the microcirculation is the regulation and distribution of oxygen carrying red blood cells within the different organs. The determinants of oxygen delivery, blood flow regulation, tissue oxygen tension, and mitochondrial well-being are not fully understood; however, it is clear that insight into the function of the microcirculation is key in this respect. In fact, it is clear that the origin of circulatory failure in critical illness unresponsive to therapy is not represented in systemic hemodynamic variables but rather in the dysfunction of the microcirculation. The introduction of bedside techniques into clinical practice that allow the evaluation of the microcirculation has opened up a new field of functional hemodynamic monitoring, identified the microcirculatory failure as the most sensitive indicator of circulatory failure associated with adverse outcome, and has provided the promise of identifying new therapeutic targets. Clinical research has identified various conventional and new therapeutic approaches that are successful in modifying the microcirculation. Current research must determine whether some of these approaches are successful in improving the outcome of critically ill patients by recruiting the microcirculation.
在临床医学的历史中，微循环在很大程度上一直被忽视，但最近在床边被认为是几个病理生理过程的中心。正常的微循环功能对于充足的组织氧合和器官功能至关重要，但它的结构理解甚少且高度异质，这与其完成的多种功能有关。微循环最重要的功能是在不同器官内调节和分配携带氧气的红细胞。氧输送、血流调节、组织氧张力和线粒体健康的决定因素尚未完全了解；然而，很明显，了解微循环的功能在这方面是关键。事实上，很明显，对治疗无反应的危重病中循环衰竭的起源并不代表在全身血流动力学变量中，而是代表微循环的功能障碍。床边技术在临床实践中的引入，使得评估微循环成为可能，开辟了功能血流动力学监测的新领域，将微循环衰竭确定为与不良预后相关的循环衰竭的最敏感指标，并提供了确定新治疗靶点的希望。临床研究已经确定了各种传统和新的治疗方法，这些方法在改善微循环方面取得了成功。目前的研究必须确定这些方法中的一些是否通过募集微循环成功改善了危重病患者的预后。
