Liu D W
Peking Union Medical College Hospital, Beijing.
Zhonghua Wai Ke Za Zhi. 1993 Sep;31(9):521-6.
Since there are still some confusions in hemodynamics and changes of oxygen delivery (DO2) in septic shock which has a high mortality, the 40 septic shock patients were observed in hemodynamics and DO2 in general ICU of Peking Union Medical College Hospital. Both surviving group and nonsurviving group had their hyperdynaminc state in hemodynamics at the beginning of septic shock. In survivors, hemodynamics were back to normal range at the 4th day of septic shock. But nonsurvivors were still in the hyperdynamic state all way to the end stage. A critical level of DO2, which was found only in survivors, was 670 ml/min.m2. The oxygen supply dependency of oxygen consumption (VO2) was found in nonsurvivors even DO2 was highly increased. The oxygen extraction (O2 ext) in nonsurvivors was lower than in survivors when DO2 was lower than critical level. We think that maintaining hyperdynamic state in septic shock does not certainly improve survival rate. In the septic shock patients with pathologic oxygen supply dependency, DO2 is not able to be increased to meet tissue oxygen demand. The changes of O2 ext have a significance in prediction of outcome of septic shock. The current therapies for septic shock have remarkable limitation. So the new treatment methods of septic shock, not only to increases DO2, should be found out for improving the survival rate further.
由于感染性休克死亡率高，其血流动力学及氧输送（DO2）变化仍存在一些困惑，故在北京协和医院综合ICU对40例感染性休克患者的血流动力学及DO2进行观察。感染性休克初期，存活组与非存活组血流动力学均处于高动力状态。存活者在感染性休克第4天血流动力学恢复至正常范围。而非存活者直至终末期一直处于高动力状态。仅在存活者中发现的DO2临界水平为670 ml/min·m2。即使DO2显著升高，非存活者仍存在氧耗（VO2）对氧供的依赖。当DO2低于临界水平时，非存活者的氧摄取率（O2 ext）低于存活者。我们认为，感染性休克时维持高动力状态不一定能提高生存率。在存在病理性氧供依赖的感染性休克患者中，无法增加DO2以满足组织氧需求。O2 ext的变化对预测感染性休克的结局具有重要意义。目前感染性休克的治疗方法存在显著局限性。因此，应寻找新的感染性休克治疗方法，不仅要增加DO2，以进一步提高生存率。
