Anzai T, Yoshida I, Kaneko T, Saito K
Second Department of Surgery, School of Medicine, Gunma University, Maebashi, Japan.
Nihon Geka Gakkai Zasshi. 1989 Feb;90(2):181-6.
The hemodynamic changes on the course of septic multiorgan failure (s-MOF), and the effects of norepinephrine administrated at septic shock state were evaluated in thirteen patients who died of s-MOF in ICU. The course in ICU was divided into following three stages. Stage I was for a few days after admission in ICU. Stage II was severe infected state. Stage III was the terminal state, i.e., a few days before death. Norepinephrine was administrated when conventional catecholamines (dopamine and/or dobutamine) could not maintain the blood pressure level in the shift from stage II to III, and the hemodynamic changes were evaluated before and after the administration. The following results were obtained: 1) Hemodynamic changes: The stage I was characterized as a moderately hyperdynamic state. The stage II exhibited a typical hyperdynamic state distinguished by a decrease in systemic vascular resistance (SVR). The stage III was distinguished as a normodynamic shock state, because of fall of cardiac output within normal control level. 2) Norepinephrine increased cardiac index, heart rate, and right ventricular stroke work index, but mean arterial pressure, stroke index and SVR did not exhibit any change. However, norepinephrine was useful aid to maintain the circulation in hypotensive state, when conventional catecholamines could not maintain blood pressure any more.
对13例在重症监护病房（ICU）死于脓毒症多器官功能衰竭（s-MOF）的患者，评估了其在脓毒症多器官功能衰竭病程中的血流动力学变化，以及在脓毒症休克状态下给予去甲肾上腺素的效果。在ICU的病程分为以下三个阶段。第一阶段为入住ICU后的几天。第二阶段为严重感染状态。第三阶段为终末期，即死亡前几天。当从第二阶段过渡到第三阶段，常规儿茶酚胺（多巴胺和/或多巴酚丁胺）无法维持血压水平时给予去甲肾上腺素，并在给药前后评估血流动力学变化。获得以下结果：1）血流动力学变化：第一阶段的特征为中度高动力状态。第二阶段表现为典型的高动力状态，其特点是全身血管阻力（SVR）降低。第三阶段为正常动力性休克状态，因为心输出量降至正常对照水平以内。2）去甲肾上腺素增加了心脏指数、心率和右心室每搏功指数，但平均动脉压、每搏指数和SVR没有任何变化。然而，当常规儿茶酚胺不再能维持血压时，去甲肾上腺素有助于维持低血压状态下的循环。
