Metrangolo L, Fiorillo M, Friedman G, Silance P G, Kahn R J, Novelli G P, Vincent J L
Department of Intensive Care, Erasme University Hospital, Free University of Brussels, Belgium.
Crit Care Med. 1995 Dec;23(12):1971-5. doi: 10.1097/00003246-199512000-00005.
To assess the relative contributions of changes in vascular tone and changes in cardiac function to hemodynamic recovery from septic shock.
Case series, observational study.
Multidisciplinary department of intensive care in an academic hospital.
Sixty-seven patients with septic shock (prolonged hypotension, signs of tissue hypoperfusion, signs of sepsis, suspected source of infection, or documented bacteremia). In addition to the antibiotic therapy and the removal of the source of sepsis whenever possible, each patient received intravenous fluids and vasoactive agents (dopamine, norepinephrine, and dobutamine). Each patient was also treated with mechanical ventilation. Twenty-four (36%) patients survived their intensive care unit course.
Hemodynamic measurements were obtained at baseline, after initial resuscitation (as soon as apparent hemodynamic stability was achieved), after 12 hrs, and after 24 hrs.
There were no significant differences in hemodynamic or oxygen-derived variables at baseline between the survivors and the nonsurvivors. During the initial resuscitation period, only the survivors demonstrated a significant increase in mean arterial pressure (from 69 +/- 17 to 82 +/- 18 mm Hg; p < .02) and left ventricular stroke work index (from 25.2 +/- 11.0 to 35.5 +/- 19.4 g.m/m2; p < .05). The increases in cardiac index and systemic vascular resistance were greater in the survivors than in the non-survivors, but the differences did not reach statistical significance. Study of the left ventricular function curves indicated an improvement of left ventricular function in the survivors but not in the nonsurvivors.
An early improvement in left ventricular function is a hallmark of the survivors from septic shock.
评估血管张力变化和心脏功能变化对感染性休克血流动力学恢复的相对贡献。
病例系列观察性研究。
一所学术医院的多学科重症监护科。
67例感染性休克患者（持续性低血压、组织灌注不足体征、脓毒症体征、疑似感染源或血行感染确诊）。除抗生素治疗及尽可能去除脓毒症源外，每位患者均接受静脉输液及血管活性药物（多巴胺、去甲肾上腺素和多巴酚丁胺）治疗。每位患者还接受机械通气治疗。24例（36%）患者存活至重症监护病房治疗过程结束。
在基线、初始复苏后（一旦达到明显的血流动力学稳定）、12小时后及24小时后进行血流动力学测量。
存活者与未存活者在基线时的血流动力学或氧衍生变量无显著差异。在初始复苏期，只有存活者的平均动脉压显著升高（从69±17 mmHg升至82±18 mmHg；p<0.02），左心室每搏功指数也显著升高（从25.2±11.0 g·m/m²升至35.5±19.4 g·m/m²；p<0.05）。存活者的心脏指数和全身血管阻力增加幅度大于未存活者，但差异未达到统计学意义。左心室功能曲线研究表明，存活者的左心室功能有所改善，而未存活者则没有。
左心室功能的早期改善是感染性休克存活者的一个标志。
