Russell J A, Phang P T
Program of Critical Care Medicine, St. Paul's Hospital, Vancouver, British Columbia, Canada.
Am J Respir Crit Care Med. 1994 Feb;149(2 Pt 1):533-7. doi: 10.1164/ajrccm.149.2.8306058.
There is no doubt that physiologic dependence of VO2 on DO2 occurs in patients in shock. Whether pathologic dependence of VO2 on DO2 occurs in the critically ill has not yet been conclusively shown, partly because of the problem of mathematical coupling of shared measurement error of cardiac output and arterial oxygen content in many studies. In our opinion, contradicting RCTs of increased DO2 and the problems encountered in the RCTs to date do not support the practice of increasing DO2 to supranormal levels. Finally, we suggest that until technology is available to better assess DO2 and VO2 of vital organs and tissues, the clinician can negotiate this controversial area in individual patients by applying careful clinical assessment and judgement of patient response to changes in DO2.
毫无疑问，休克患者存在VO₂对DO₂的生理依赖。危重症患者是否存在VO₂对DO₂的病理依赖尚未得到确凿证实，部分原因是许多研究中心输出量和动脉血氧含量共同测量误差的数学耦合问题。我们认为，增加DO₂的随机对照试验相互矛盾，以及迄今为止随机对照试验中遇到的问题，均不支持将DO₂提高到超常水平的做法。最后，我们建议，在有技术能够更好地评估重要器官和组织的DO₂和VO₂之前，临床医生可以通过仔细的临床评估以及判断患者对DO₂变化的反应，来处理个别患者中这个有争议的领域。
