Ognibene F P, Parker M M, Natanson C, Shelhamer J H, Parrillo J E
Critical Care Medicine Department, National Institutes of Health, Bethesda 20892.
Chest. 1988 May;93(5):903-10. doi: 10.1378/chest.93.5.903.
Volume infusion, to increase preload and to enhance ventricular performance, is accepted as initial management of septic shock. Recent evidence has demonstrated depressed myocardial function in human septic shock. We analyzed left ventricular performance during volume infusion using serial data from simultaneously obtained pulmonary artery catheter hemodynamic measurements and radionuclide cineangiography. Critically ill control subjects (n = 14), patients with sepsis but without shock (n = 21), and patients with septic shock (n = 21) had prevolume infusion hemodynamic measurements determined and received statistically similar volumes of fluid resulting in similar increases in pulmonary capillary wedge pressure. There was a strong trend (p = 0.004) toward less of a change in left ventricular stroke work index (LVSWI) after volume infusion in patients with sepsis and septic shock compared with control subjects. The LVSWI response after volume infusion was significantly less in patients with septic shock when compared with critically ill control subjects (p less than 0.05). These data demonstrate significantly altered ventricular performance, as measured by LVSWI, in response to volume infusion in patients with septic shock.
通过增加血容量来提高前负荷并增强心室功能，被公认为是感染性休克的初始治疗方法。最近有证据表明，感染性休克患者存在心肌功能抑制。我们利用同步获得的肺动脉导管血流动力学测量数据和放射性核素电影血管造影术的系列数据，分析了容量输注期间的左心室功能。对危重症对照受试者（n = 14）、脓毒症但无休克患者（n = 21）以及感染性休克患者（n = 21）进行了容量输注前血流动力学测量，并给予统计学上相似的液体量，导致肺毛细血管楔压有相似程度的升高。与对照受试者相比，脓毒症和感染性休克患者在容量输注后左心室每搏功指数（LVSWI）的变化趋势明显较小（p = 0.004）。与危重症对照受试者相比，感染性休克患者在容量输注后的LVSWI反应明显较小（p < 0.05）。这些数据表明，以LVSWI衡量，感染性休克患者在容量输注后的心室功能发生了显著改变。
