Perret C
Schweiz Med Wochenschr. 1980 Jan 12;110(2):56-61.
Septic shock usually induces a hyperdynamic state characterized by normal or high cardiac output, associated with a fall in peripheral resistances which is responsible for arterial hypotension; when the evolution is prolonged it usually leads to a low output syndrome with elevated peripheral resistances, suggesting the hemodynamic pattern of hypovolemic shock. All intermediate situations can be observed within these extremes. The hyperdynamic state corresponds to a decrease in aortic impedance, which is indirectly related to the effects of endotoxin on vascular bed. The low output syndrome is more usual at the advanced stage and corresponds to the intervention of associated factors such as progressive hypovolemia and/or myocardial dysfunction. In certain cases--e.g. peritonitis--septic shock is immediately associated with hypovolemia. Many hypotheses have been advanced to explain the circulatory, cardiac and metabolic effects of septic shock. The effect of kinines on the circulation appears to predominate but there are still many unanswered questions concerning the real sequence of events. Hemodynamic monitoring is of great advantage in identifying the type of circulatory distortion, determining its severity, guiding therapy and evaluating its effects.
感染性休克通常会引发一种高动力状态，其特征为心输出量正常或升高，同时伴有外周阻力下降，这是导致动脉低血压的原因；若病程延长，通常会导致外周阻力升高的低输出综合征，提示低血容量性休克的血流动力学模式。在这些极端情况之间可以观察到所有中间状态。高动力状态对应主动脉阻抗降低，这与内毒素对血管床的作用间接相关。低输出综合征在晚期更为常见，并且与诸如进行性血容量减少和/或心肌功能障碍等相关因素的干预有关。在某些情况下，如腹膜炎，感染性休克会立即伴有血容量减少。人们提出了许多假说来解释感染性休克的循环、心脏和代谢效应。激肽对循环的影响似乎占主导地位，但关于实际事件顺序仍有许多未解决的问题。血流动力学监测在识别循环扭曲类型、确定其严重程度、指导治疗和评估其效果方面具有很大优势。
