Gilbert E M, Haupt M T, Mandanas R Y, Huaringa A J, Carlson R W
Am Rev Respir Dis. 1986 Nov;134(5):873-8. doi: 10.1164/arrd.1986.134.5.873.
Fifty-four patients with systemic sepsis and signs of circulatory shock were prospectively investigated immediately before and after 1 of 3 therapeutic interventions chosen to increase systemic oxygen delivery (DO2): colloidal fluid loading (Group I, n = 20), blood transfusion (Group II, n = 17), or catecholamine infusion (dopamine or dobutamine, Group III, n = 17). Patients in Groups I and II with normal blood lactate concentrations (less than 2.2 mmol/L) exhibited no significant increases in systemic oxygen consumption (VO2) in response to the increases in DO2. However, significant increases in VO2 were noted in patients in Groups I and II with elevated lactate concentrations (greater than 2.2 mmol/L). In contrast to patients in Groups I and II, patients in Group III with and without lactic acidosis exhibited significant increases in VO2 after catecholamine administration. Lactic acidosis, a clinical marker of anaerobic metabolism or oxygen debt, appears to predict increases in VO2 in response to increases in DO2 in septic patients receiving fluid and catecholamines increase VO2 without regard for the presence or absence of anaerobic metabolism. The results of this clinical trial therefore suggest that catecholamines may exert a direct effect on oxidative metabolism.
对54例患有全身性脓毒症且有循环性休克体征的患者进行了前瞻性研究，在选择的3种旨在增加全身氧输送（DO2）的治疗干预措施中的1种实施之前和之后立即进行调查：胶体液输注（第一组，n = 20）、输血（第二组，n = 17）或儿茶酚胺输注（多巴胺或多巴酚丁胺，第三组，n = 17）。第一组和第二组中血乳酸浓度正常（低于2.2 mmol/L）的患者，其全身氧消耗（VO2）并未因DO2的增加而显著增加。然而，第一组和第二组中乳酸浓度升高（大于2.2 mmol/L）的患者，VO2有显著增加。与第一组和第二组患者不同,第三组中有和没有乳酸性酸中毒的患者在给予儿茶酚胺后VO2均显著增加。乳酸性酸中毒是无氧代谢或氧债的临床标志，似乎可预测脓毒症患者在DO2增加时VO2的增加，接受液体和儿茶酚胺治疗的患者VO2增加，而不考虑有无无氧代谢。因此，该临床试验结果提示，儿茶酚胺可能对氧化代谢有直接作用。
