Siegel J H, Giovannini I, Coleman B, Cerra F B, Nespoli A
Arch Surg. 1982 Feb;117(2):225-38. doi: 10.1001/archsurg.1982.01380260091016.
Multivariable physiologic studies of cardiovascular, respiratory, and metabolic functions were performed in 341 patients (884 studies). Eighty patients had cirrhotic liver disease, 64 had sepsis, 87 had nonseptic cariogenic syndromes, and 110 had nonseptic general surgical or traumatic injury. The group with cirrhosis had the highest cardiac index and ejection fraction. When compared with the group with nonseptic surgery or trauma, vascular tone was reduced in the patients with cirrhosis or sepsis and was lowest in patients with both conditions. Ventricular function was good in the groups with cirrhosis or sepsis, due to the additive effect in reducing vascular tone that allowed ejection fraction to increase, but caused the ratio of alveolar ventilation to perfusion (VA/QT) to fall, resulting in a greater perfusion of a decreased pulmonary vascular bed. The falls in vascular tone and VA/QT in patients with cirrhosis or sepsis result from the reduced oxygen consumption that occurs due to metabolic imbalance (B state). This B state seems to reflect a hepatic inability to metabolize aromatic amino acids, so that levels of tyrosine, phenylalanine, and the false neurotransmitter octopamine increase. These mechanisms are pathologically synergistic when sepsis and cirrhosis occur together.
对341例患者（共进行884项研究）进行了心血管、呼吸和代谢功能的多变量生理学研究。其中80例患有肝硬化，64例患有脓毒症，87例患有非脓毒性致病毒综合征，110例患有非脓毒性普通外科手术或创伤。肝硬化组的心脏指数和射血分数最高。与非脓毒性手术或创伤组相比，肝硬化或脓毒症患者的血管张力降低，两种情况同时存在的患者血管张力最低。肝硬化或脓毒症组的心室功能良好，这是因为降低血管张力的叠加效应使射血分数增加，但导致肺泡通气与灌注比（VA/QT）下降，从而使减少的肺血管床灌注增加。肝硬化或脓毒症患者血管张力和VA/QT的下降是由于代谢失衡（B状态）导致的氧消耗减少所致。这种B状态似乎反映了肝脏无法代谢芳香族氨基酸，从而使酪氨酸、苯丙氨酸和假性神经递质章鱼胺水平升高。当脓毒症和肝硬化同时发生时，这些机制在病理上具有协同作用。
