Duff J H
Heart Lung. 1976 Sep-Oct;5(5):772-6.
The hyperdynamic circulation characteristic of severe sepsis is not likely due to peripheral arteriovenous shunts since in skeletal muscle, at least, capillary blood flow is increased and varies directly with cardiac index. The finding that flow is normal in some septic patients who are severely ill and close to death suggests that blood flow can no longer be considered the critical factor explaining the death of the septic patient. Clearly, the commonly accepted sequence of low blood flow, tissue hypoxia, lactacidosis, and death does not apply to all patients dying from shock. The hyperdynamic circulatory state and the metabolic changes associated with severe sepsis may be related. Skeletal muscle capillary blood flow was increased in fasting normal subjects and septic postoperative patients, both of whom were catabolic. Therefore, elevated blood flow, which is characteristic of severe sepsis, may be a response to the catabolism of body protein required for energy production. If this concept of sepsis is accepted, it follows that treatment which heretofore has been aimed at increasing blood flow and blood pressure should be redirected to therapy which provides energy substrates and alters hormonal patterns to favor anabolism.
严重脓毒症的高动力循环特征不太可能是由于外周动静脉分流所致，因为至少在骨骼肌中，毛细血管血流量增加且与心脏指数直接相关。一些病情严重且濒临死亡的脓毒症患者血流正常这一发现表明，血流不再能被视为解释脓毒症患者死亡的关键因素。显然，普遍接受的低血流、组织缺氧、乳酸性酸中毒和死亡的顺序并不适用于所有死于休克的患者。严重脓毒症相关的高动力循环状态和代谢变化可能有关联。禁食的正常受试者和脓毒症术后患者（二者均处于分解代谢状态）的骨骼肌毛细血管血流量均增加。因此，严重脓毒症的特征性高血流量可能是对能量产生所需身体蛋白质分解代谢的一种反应。如果接受这种脓毒症概念，那么以往旨在增加血流和血压的治疗就应转向提供能量底物并改变激素模式以利于合成代谢的治疗。
