Wong H R, Carcillo J A, Burckart G, Shah N, Janosky J E
Department of Anesthesiology, University of Pittsburgh School of Medicine, PA, USA.
Crit Care Med. 1995 May;23(5):835-42. doi: 10.1097/00003246-199505000-00010.
To measure total serum nitrite and nitrate concentrations in children with the sepsis syndrome as an indicator of endogenous nitric oxide production. To determine if there is an association between total serum nitrite and nitrate concentrations and vascular responsiveness to norepinephrine.
A prospective, clinical study.
Tertiary, multidisciplinary, pediatric intensive care unit.
Thirty-one children with the sepsis syndrome, 18 of whom were also hypotensive. Sixteen critically ill children without signs of the sepsis syndrome served as controls.
Blood samples were obtained from indwelling catheters. The norepinephrine dose to reach the age appropriate, 50th percentile mean arterial blood pressure was determined in patients receiving norepinephrine.
Total serum nitrite and nitrate concentrations were measured on the first three days after the recognition of the sepsis syndrome. Patients with the sepsis syndrome had increased mean total serum nitrite and nitrate concentrations (day 1, 118 +/- 93 microM; day 2, 112 +/- 94 microM; day 3, 112 +/- 93 microM) vs. controls (43 +/- 24 microM, p < .05) on all 3 days. When sepsis syndrome patients were separated into nonhypotensive and hypotensive groups, only the patients with hypotension had increased concentrations vs. controls on all three days (p < .05). Sepsis syndrome patients with hypotension also had higher total serum nitrite and nitrate concentrations (145 +/- 97 microM) than sepsis syndrome patients without hypotension (82 +/- 76 microM, p < .05) on day 1. In five patients receiving norepinephrine infusions, increased total serum nitrite and nitrate concentrations were associated with higher norepinephrine requirements to maintain an age-appropriate, 50th percentile mean arterial blood pressure on each of the three study days (day 1, rs = 0.821, p < .05; day 2, rs = 0.900, p < .05; day 3, rs = 0.872, p < .05).
Children with the sepsis syndrome, particularly those patients with hypotension, have increased total serum nitrite and nitrate concentrations that likely reflect increased endogenous production of nitric oxide. Vascular hyporesponsiveness to norepinephrine during the sepsis syndrome may be, in part, a nitric oxide-mediated process.
测量脓毒症综合征患儿血清亚硝酸盐和硝酸盐的总浓度，以此作为内源性一氧化氮生成的指标。确定血清亚硝酸盐和硝酸盐总浓度与血管对去甲肾上腺素反应性之间是否存在关联。
一项前瞻性临床研究。
三级多学科儿科重症监护病房。
31例脓毒症综合征患儿，其中18例同时存在低血压。16例无脓毒症综合征体征的危重症患儿作为对照。
通过留置导管采集血样。对于接受去甲肾上腺素治疗的患者，确定达到年龄相应的第50百分位平均动脉血压所需的去甲肾上腺素剂量。
在识别脓毒症综合征后的头三天测量血清亚硝酸盐和硝酸盐的总浓度。脓毒症综合征患儿的血清亚硝酸盐和硝酸盐总平均浓度在所有三天均高于对照组（第1天，118±93μM；第2天，112±94μM；第3天，112±93μM），而对照组为43±24μM（p<0.05）。当将脓毒症综合征患者分为非低血压组和低血压组时，只有低血压患者在所有三天的浓度均高于对照组（p<0.05）。脓毒症综合征低血压患者在第1天的血清亚硝酸盐和硝酸盐总浓度（145±97μM）也高于无低血压的脓毒症综合征患者（82±76μM，p<0.05）。在5例接受去甲肾上腺素输注的患者中，血清亚硝酸盐和硝酸盐总浓度升高与在三个研究日中每日维持年龄相应的第50百分位平均动脉血压所需的更高去甲肾上腺素剂量相关（第1天，rs = 0.821，p<0.05；第2天，rs = 0.900，p<0.05；第3天，rs = 0.872，p<0.05）。
脓毒症综合征患儿，尤其是低血压患儿，血清亚硝酸盐和硝酸盐总浓度升高，这可能反映内源性一氧化氮生成增加。脓毒症综合征期间血管对去甲肾上腺素反应性降低可能部分是由一氧化氮介导的过程。
