Antonucci Elio, Fiaccadori Enrico, Donadello Katia, Taccone Fabio Silvio, Franchi Federico, Scolletta Sabino
Department of Clinical and Experimental Medicine, University of Parma Medical School, Parma, Italy.
Department of Intensive Care, Erasme University Hospital, Université de Bruxelles (ULB), Brussels, Belgium.
J Crit Care. 2014 Aug;29(4):500-11. doi: 10.1016/j.jcrc.2014.03.028. Epub 2014 Apr 5.
The cardiovascular system plays a key role in sepsis, and septic myocardial depression is a common finding associated with increased morbidity and mortality. Myocardial depression during sepsis is not clearly defined, but it can perhaps be best described as a global (systolic and diastolic) dysfunction of both the left and right sides of the heart. The pathogenesis of septic myocardial depression involves a complex mix of systemic (hemodynamic) factors and genetic, molecular, metabolic, and structural alterations. Pulmonary artery catheterization and modern echo-Doppler techniques are important diagnostic tools in this setting. There are no specific therapies for septic myocardial depression, and the cornerstone of management is control of the underlying infectious process (adequate antibiotic therapy, removal of the source) and hemodynamic stabilization (fluids, vasopressor and inotropic agents). In this review, we will summarize the pathogenesis, diagnosis, and treatment of myocardial depression in sepsis. Additional studies are needed in order to improve diagnosis and identify therapeutic targets in septic myocardial dysfunction.
心血管系统在脓毒症中起关键作用，脓毒症性心肌抑制是一种常见表现，与发病率和死亡率增加相关。脓毒症期间的心肌抑制尚无明确定义，但或许可以最好地描述为心脏左右两侧的整体（收缩期和舒张期）功能障碍。脓毒症性心肌抑制的发病机制涉及全身（血流动力学）因素与遗传、分子、代谢和结构改变的复杂组合。在这种情况下，肺动脉导管插入术和现代超声多普勒技术是重要的诊断工具。对于脓毒症性心肌抑制没有特异性治疗方法，管理的基石是控制潜在的感染过程（充分的抗生素治疗、去除感染源）和血流动力学稳定（补液、血管加压药和正性肌力药物）。在本综述中，我们将总结脓毒症中心肌抑制的发病机制、诊断和治疗。需要进行更多研究以改善诊断并确定脓毒症性心肌功能障碍的治疗靶点。
