Shoemaker W C, Appel P L, Kram H B
Department of Surgery, Martin Luther King, Jr. Hospital Charles R. Drew University, UCLA School of Medicine.
Intensive Care Med. 1990;16 Suppl 2:S135-44. doi: 10.1007/BF01785243.
Survivors of high-risk general (noncardiac) surgery were observed to have cardiac index (CI) values averaging 4.5 l/min.m2, oxygen delivery (DO2) of greater than 600 ml/min.m2, and oxygen consumption (VO2) of 170 ml/min.m2. In contrast, these values were relatively normal in patients who subsequently died. A very early predictive index based on these observations was found to predict outcome in 94% of high-risk patients. The hypotheses that increased DO2 and VO2 in the survivors represent compensatory physiologic responses and that these values were appropriate therapeutic goals were tested in prospective randomized clinical trials and found to reduce mortality and morbidity significantly. The optimal goals were more easily attained with colloids, red cells, dobutamine, and vasodilators, according to their capacity to improve tissue perfusion, as reflected by increased flow and oxygen transport. The extremely complex interactions between DO2 and VO2 are reviewed.
观察发现，高危普通（非心脏）手术幸存者的心脏指数（CI）平均为4.5升/分钟·平方米，氧输送（DO2）大于600毫升/分钟·平方米，氧消耗（VO2）为170毫升/分钟·平方米。相比之下，随后死亡的患者这些值相对正常。基于这些观察结果得出的一个非常早期的预测指标被发现可预测94%的高危患者的预后。在一项前瞻性随机临床试验中，对幸存者中增加的DO2和VO2代表代偿性生理反应以及这些值是合适的治疗目标这两个假设进行了检验，结果发现这些假设可显著降低死亡率和发病率。根据胶体、红细胞、多巴酚丁胺和血管扩张剂改善组织灌注的能力（以血流量和氧输送增加为反映），更容易实现最佳目标。本文对DO2和VO2之间极其复杂的相互作用进行了综述。
