George C, Regnier B, Le Gall J R, Gastinne H, Carlet J, Rapin M
Intensive Care Med. 1978 Jul;4(3):159-63. doi: 10.1007/BF01700259.
A case of severe hypovolaemic shock related to idiopathic oedema was observed in a 37 year old woman. Large plasma volume expansion (nearly 12 1 over 9 hours) did not change the clinical status. Haemodynamic studies showed low cardiac index (1.1 1/min/m2), decreased left ventricular stroke work index (6.7 gm/m2), and high systemic arterial resistance (52 mmHg/1/min/m2). Dopamine infusion improved the haemodynamic condition which returned to normal 30 hours after the beginning of shock. After recovery, capillary permeability measured by a modification of Landis' method was markedly increased. A study of albumin metabolism showed a normal intravascular pool and a rapid exchange compartment with a twofold increase in slow exchange compartment. Hormonal levels and complement fractions were within normal limits. Serum protein immuno-electrophoresis showed an abnormal IgG. These results clearly demonstrate that hypovolaemia is related to increased capillary permeability and leakage of albumin out of the vascular space. When large infusions fail, inotropic agents, especially Dopamine, should be used in such cases.
一名37岁女性患者出现了与特发性水肿相关的严重低血容量性休克。大量扩容（9小时内近12升）并未改变临床状况。血流动力学研究显示心脏指数低（1.1升/分钟/平方米），左心室每搏功指数降低（6.7克米/平方米），全身动脉阻力高（52毫米汞柱/升/分钟/平方米）。多巴胺输注改善了血流动力学状况，休克开始30小时后恢复正常。恢复后，采用改良兰迪斯方法测量的毛细血管通透性明显增加。白蛋白代谢研究显示血管内池正常，快速交换池正常，缓慢交换池增加了两倍。激素水平和补体成分在正常范围内。血清蛋白免疫电泳显示IgG异常。这些结果清楚地表明，低血容量与毛细血管通透性增加和白蛋白从血管间隙渗漏有关。当大量输液无效时，此类病例应使用强心剂，尤其是多巴胺。
