Parker M M, McCarthy K E, Ognibene F P, Parrillo J E
Critical Care Medicine Department, Warren G. Magnuson Clinical Center, National Institutes of Health, Bethesda, MD 20892.
Chest. 1990 Jan;97(1):126-31. doi: 10.1378/chest.97.1.126.
Septic shock in humans is usually characterized by a high cardiac output, a low systemic vascular resistance, reversible depression of left ventricular ejection fraction, and transient left ventricular dilatation. The relationship of left ventricular to right ventricular function in septic shock is poorly understood. To evaluate right ventricular vs left ventricular performance and to evaluate the relation of biventricular performance to survival, we performed serial hemodynamic and radionuclide angiographic studies in 39 patients with septic shock. Right ventricular ejection fraction was calculated using the two regions of interest method. There were 22 survivors and 17 nonsurvivors. Comparing initial with final (after recovery for survivors; within 24 hours of death for nonsurvivors) studies, each survivor's cardiovascular performance returned toward normal, with significant increases in mean arterial pressure, left and right ventricular ejection fraction, and right ventricular stroke work index. Their profiles also demonstrated significant decreases in central venous pressure, pulmonary artery wedge pressure, pulmonary artery mean pressure, and left and right ventricular end-diastolic volume indices. From initial to final study in the nonsurvivors, there was a statistically significant increase in heart rate but no change in any other cardiovascular parameter, indicating a persistence of the initial cardiovascular dysfunction until death. Comparing serial studies, the pattern of change in right vs left ventricular function was very similar (same direction in 82 percent of patients). Thus, myocardial depression in human septic shock affects both ventricles simultaneously with a similar pattern of dysfunction.
人类脓毒性休克通常表现为心输出量高、全身血管阻力低、左心室射血分数可逆性降低以及短暂的左心室扩张。脓毒性休克中左心室与右心室功能的关系尚不清楚。为了评估右心室与左心室的功能，并评估双心室功能与生存率的关系，我们对39例脓毒性休克患者进行了系列血流动力学和放射性核素血管造影研究。右心室射血分数采用感兴趣区法计算。有22例幸存者和17例非幸存者。将初始研究与最终研究（幸存者恢复后；非幸存者死亡后24小时内）进行比较，每位幸存者的心血管功能恢复正常，平均动脉压、左心室和右心室射血分数以及右心室每搏功指数显著增加。他们的指标还显示中心静脉压、肺动脉楔压、肺动脉平均压以及左心室和右心室舒张末期容积指数显著降低。在非幸存者中，从初始研究到最终研究，心率有统计学意义的增加，但其他心血管参数无变化，表明初始心血管功能障碍持续至死亡。比较系列研究，右心室与左心室功能的变化模式非常相似（82%的患者变化方向相同）。因此，人类脓毒性休克中的心肌抑制同时影响两个心室，功能障碍模式相似。
