Martin L, Derwall M, Thiemermann C, Schürholz T
Klinik für Operative Intensivmedizin und Intermediate Care, Uniklinik RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Deutschland.
The William Harvey Research Center, Centre for Translational Medicine & Therapeutics, Queen Mary University London, London, Großbritannien.
Anaesthesist. 2017 Jul;66(7):479-490. doi: 10.1007/s00101-017-0329-x.
An impairment of cardiac function is a key feature of cardiovascular failure associated with sepsis; however, its clinical relevance is still underestimated. Recent advancements in echocardiography in patients with septic shock enable a better characterization of septic cardiomyopathy by unmasking a severe, cardiac dysfunction even in the presence of preserved left ventricular ejection fraction. The pathophysiology of septic cardiomyopathy involves a complex mixture of systemic factors and molecular, metabolic, and structural changes of the cardiomyocytes. A better understanding of these factors will enable the discovery of new therapeutic targets for urgently needed disease-modifying therapeutic interventions. To date, the cornerstone of therapeutic management lies in control of the underlying infectious process and hemodynamic stabilization. This review summarizes the pathogenesis, diagnosis, and treatment of septic cardiomyopathy, and highlights the importance of further urgently needed studies aimed at improving diagnosis and treatment for septic cardiomyopathy.
心功能损害是脓毒症相关心血管功能衰竭的关键特征；然而，其临床相关性仍被低估。脓毒性休克患者超声心动图的最新进展能够更好地描述脓毒症性心肌病，即使在左心室射血分数正常的情况下也能发现严重的心脏功能障碍。脓毒症性心肌病的病理生理学涉及全身因素与心肌细胞分子、代谢和结构变化的复杂混合。更好地理解这些因素将有助于发现急需的疾病改善性治疗干预的新治疗靶点。迄今为止，治疗管理的基石在于控制潜在的感染过程和血流动力学稳定。本综述总结了脓毒症性心肌病的发病机制、诊断和治疗，并强调了进一步开展急需研究以改善脓毒症性心肌病诊断和治疗的重要性。
