Merz Tamara, Denoix Nicole, Huber-Lang Markus, Singer Mervyn, Radermacher Peter, McCook Oscar
Institute for Anesthesiological Pathophysiology and Process Engineering, Ulm University Medical Center, Ulm, Germany.
Clinic for Psychosomatic Medicine and Psychotherapy, Ulm University Medical Center, Ulm, Germany.
Front Med (Lausanne). 2020 Aug 5;7:416. doi: 10.3389/fmed.2020.00416. eCollection 2020.
Circulatory shock is associated with marked disturbances of the macro- and microcirculation and flow heterogeneities. Furthermore, a lack of tissue adenosine trisphosphate (ATP) and mitochondrial dysfunction are directly associated with organ failure and poor patient outcome. While it remains unclear if microcirculation-targeted resuscitation strategies can even abolish shock-induced flow heterogeneity, mitochondrial dysfunction and subsequently diminished ATP production could still lead to organ dysfunction and failure even if microcirculatory function is restored or maintained. Preserved mitochondrial function is clearly associated with better patient outcome. This review elucidates the role of the microcirculation and mitochondria during circulatory shock and patient management and will give a viewpoint on the advantages and disadvantages of tailoring resuscitation to microvascular or mitochondrial targets.
循环性休克与大循环和微循环的显著紊乱以及血流异质性有关。此外，组织三磷酸腺苷（ATP）缺乏和线粒体功能障碍与器官衰竭及患者不良预后直接相关。虽然尚不清楚以微循环为靶点的复苏策略是否能消除休克引起的血流异质性，但即使微循环功能得以恢复或维持，线粒体功能障碍及随后ATP生成减少仍可能导致器官功能障碍和衰竭。线粒体功能的保留显然与患者更好的预后相关。本综述阐明了微循环和线粒体在循环性休克及患者管理中的作用，并将对针对微血管或线粒体靶点进行复苏的利弊提出观点。
