Cunnion R E, Schaer G L, Parker M M, Natanson C, Parrillo J E
Circulation. 1986 Apr;73(4):637-44. doi: 10.1161/01.cir.73.4.637.
Reversible myocardial depression, manifested by ventricular dilatation and decreased ejection fraction, is common in human septic shock. A proposed mechanism, based on animal studies, is myocardial ischemia resulting from inadequate coronary blood flow. Coronary flow observations have not been reported for human septic shock. To determine whether myocardial depression in human septic shock is associated with reduced coronary flow, thermodilution coronary sinus catheters were placed in seven patients with septic shock for measurements of coronary flow and myocardial metabolism. Four of the seven patients developed myocardial depression. These patients had coronary flow similar to or higher than that of control subjects and similar to that of the other three patients, who did not develop myocardial depression. None of the patients had net myocardial lactate production. In general, compared with values in control subjects, the oxygen content difference (arterial minus coronary sinus) was narrowed, and the fractional extraction of arterial oxygen was diminished. This pattern of disordered coronary autoregulation is analogous to the pattern of arteriovenous shunting in other organs in patients with septic shock. The preservation of coronary flow, the net myocardial lactate extraction, and the increased availability of oxygen to the myocardium argue against global ischemia as the cause of myocardial depression in human septic shock.
可逆性心肌抑制表现为心室扩张和射血分数降低，在人类感染性休克中很常见。基于动物研究提出的一种机制是冠状动脉血流不足导致的心肌缺血。尚未有关于人类感染性休克冠状动脉血流的观察报告。为了确定人类感染性休克中的心肌抑制是否与冠状动脉血流减少有关，对7例感染性休克患者置入热稀释冠状动脉窦导管，以测量冠状动脉血流和心肌代谢。7例患者中有4例出现心肌抑制。这些患者的冠状动脉血流与对照组相似或更高，且与另外3例未出现心肌抑制的患者相似。所有患者均无心肌乳酸净生成。总体而言，与对照组相比，氧含量差（动脉血减去冠状窦血）变窄，动脉血氧分数提取减少。这种冠状动脉自身调节紊乱的模式类似于感染性休克患者其他器官的动静脉分流模式。冠状动脉血流的保留、心肌乳酸的净摄取以及心肌氧供应的增加表明，全身性缺血并非人类感染性休克中心肌抑制的原因。
