高动力型感染性休克且氧摄取率低的儿童氧耗量对氧输送的依赖性

Dependence of oxygen consumption on oxygen delivery in children with hyperdynamic septic shock and low oxygen extraction.

作者信息

Lucking S E, Williams T M, Chaten F C, Metz R I, Mickell J J

机构信息

Department of Pediatrics, Children's Medical Center, Medical College of Virginia, Richmond.

出版信息

Crit Care Med. 1990 Dec;18(12):1316-9. doi: 10.1097/00003246-199012000-00002.

DOI:10.1097/00003246-199012000-00002

PMID:2245603

Abstract

We studied the effect of increasing systemic oxygen delivery (DO2) by packed RBC (PRBC) transfusion on oxygen consumption (VO2) in children with hyperdynamic septic shock. After routine resuscitation with volume loading and pharmacologic support, patients were studied if they had significant derangements of oxygen transport variables defined as: baseline VO2 less than 180 ml/min.m2 and oxygen extraction (O2 extr) less than 24%. Eight studies were performed. PRBC transfusion increased DO2 from 636 +/- 167 to 828 +/- 266 ml/min.m2 (p less than .01) without increasing cardiac index (5.2 +/- 1.3 vs. 5.0 +/- 1.4 L/min.m2). VO2 increased from 112 +/- 36 to 157 +/- 60 ml/min.m2 (p less than .01) while O2 extr was unchanged (18 +/- 3% vs. 19 +/- 6%). Despite initial low O2 extr, VO2 can be increased in pediatric septic shock by a further increase in DO2. Since VO2 correlates with survival, one should consider enhancing DO2 further despite initial low O2 extr and high DO2. Effects on morbidity and mortality require further study.

摘要

我们研究了通过输注浓缩红细胞（PRBC）增加全身氧输送（DO2）对高动力性感染性休克患儿氧消耗（VO2）的影响。在进行容量负荷和药物支持的常规复苏后，若患者存在氧转运变量的显著紊乱，即定义为：基线VO2低于180 ml/min·m2且氧摄取率（O2 extr）低于24%，则对其进行研究。共进行了八项研究。PRBC输注使DO2从636±167增加至828±266 ml/min·m2（p<0.01），而心脏指数未增加（5.2±1.3与5.0±1.4 L/min·m2）。VO2从112±36增加至157±60 ml/min·m2（p<0.01），而O2 extr无变化（18±3%与19±6%）。尽管初始时O2 extr较低，但在小儿感染性休克中，通过进一步增加DO2可使VO2增加。由于VO2与生存率相关，尽管初始时O2 extr较低且DO2较高，仍应考虑进一步提高DO2。对发病率和死亡率的影响需要进一步研究。