Lenz K, Kleinberger G, Hörtnagl H, Base W, Druml W, Laggner A
Wien Klin Wochenschr. 1985 May 10;97(10):469-74.
Haemodynamic data were obtained in 26 patients with hepatic failure admitted to the intensive care unit of the First Department of Medicine, Vienna University. There was a significant increase in heart rate (101 vs 78 beats/min) and decreased diastolic pressure (56 vs 71 mm Hg) as compared with healthy persons. The cardiac index was elevated (5.1 vs 3.5 l/m2) and the total peripheral resistance was lowered (621 vs 1130 dyn/sec/cm-5). The systolic blood pressure was within the normal range except in 8 patients whose illness was complicated by sepsis. In those 8 patients the systolic blood pressure (86 vs 128 mm Hg), the diastolic blood pressure (42 vs 61 mm Hg) and the total peripheral resistance (434 vs 764 dyn. sec. cm-5) were all decreased as compared with patients with hepatocellular disease without sepsis. The decreased total peripheral resistance, however, was not associated with a further increase in the heart rate or stroke volume. On the contrary, in these 8 patients the left ventricular performance was lowered. The increase in cardiac output was not associated with an increase in oxygen consumption in patients without sepsis. Oxygen consumption was increased in patients with hepatocellular insufficiency and sepsis (157 ml/m2 vs 123 ml/m2) and this was accompanied by a diminished oxygen extraction rate (16% vs 26% in these 8 patients.
对维也纳大学第一医学部重症监护病房收治的26例肝衰竭患者进行了血流动力学数据测定。与健康人相比，患者心率显著增加（101次/分钟 vs 78次/分钟），舒张压降低（56 mmHg vs 71 mmHg）。心脏指数升高（5.1 l/m² vs 3.5 l/m²），总外周阻力降低（621 dyn/sec/cm⁻⁵ vs 1130 dyn/sec/cm⁻⁵）。除8例并发脓毒症的患者外，收缩压在正常范围内。与无脓毒症的肝细胞疾病患者相比，这8例患者的收缩压（86 mmHg vs 128 mmHg）、舒张压（42 mmHg vs 61 mmHg）和总外周阻力（434 dyn. sec. cm⁻⁵ vs 764 dyn. sec. cm⁻⁵）均降低。然而，总外周阻力降低并未伴随心率或每搏输出量进一步增加。相反，这8例患者的左心室功能降低。无脓毒症患者的心输出量增加与氧耗增加无关。肝细胞功能不全并发脓毒症的患者氧耗增加（157 ml/m² vs 123 ml/m²），同时氧摄取率降低（这8例患者中为16% vs 26%）。
