Cunnion R E, Parrillo J E
Critical Care Medicine Department, National Institutes of Health, Bethesda, Maryland.
Crit Care Clin. 1989 Jan;5(1):99-118.
The characteristic hemodynamic profile of human septic shock consists of a normal or elevated cardiac index and a decreased systemic vascular resistance index. When a patient with septic shock has a low cardiac index, concomitant hypovolemia is usually present. Within 48 hours of the onset of septic shock, most patients develop marked dilatation of both ventricles, depressed ejection fractions, and alterations of the Frank-Starling and diastolic pressure-volume relationships; stroke volume typically is well maintained. In surviving patients, cardiac function returns to normal within 10 days. An identical sequence of hemodynamic abnormalities occurs in an experimental canine model of sepsis that employs intraperitoneal implantation of infected fibrin clots. This myocardial dysfunction is not due to global myocardial ischemia; instead, there appear to be one or more circulating myocardial depressant substances. The chemical nature of these circulation mediators is under intensive investigation clinically, in vitro, and in the canine model.
人类感染性休克的典型血流动力学特征包括心指数正常或升高以及全身血管阻力指数降低。当感染性休克患者的心指数较低时，通常存在并发的血容量不足。在感染性休克发作后的48小时内，大多数患者会出现双心室明显扩张、射血分数降低以及Frank-Starling定律和舒张期压力-容积关系的改变；每搏输出量通常能得到良好维持。在存活的患者中，心功能在10天内恢复正常。在采用腹腔内植入感染性纤维蛋白凝块的脓毒症实验犬模型中，会出现相同的血流动力学异常序列。这种心肌功能障碍并非由于整体心肌缺血；相反，似乎存在一种或多种循环心肌抑制物质。这些循环介质的化学性质正在临床、体外和犬模型中进行深入研究。
