Hayes M A, Yau E H, Timmins A C, Hinds C J, Watson D
Department of Anaesthesia, St. Bartholomew's Hospital, London, England.
Chest. 1993 Mar;103(3):886-95. doi: 10.1378/chest.103.3.886.
To evaluate the response to therapy aimed at achieving supranormal cardiac and oxygen transport variables (cardiac index [CI] > 4.5 L/min/m2, oxygen delivery [DO2] > 600 ml/min/m2, and oxygen consumption [VO2] > 170 ml/min/m2) in a heterogenous group of critically ill patients and to assess its relationship to outcome.
Patients were divided retrospectively into two groups. Group 1 (n = 15) achieved supranormal values for CI, DO2 and VO2 simultaneously during the first 24 h. Group 2 (n = 17) failed to achieve these goals simultaneously at any time point.
General intensive care units in a teaching and a district general hospital.
Thirty-two patients at risk of developing multiple organ failure were studied prospectively.
Patients received volume expansion and then, if necessary, dobutamine (5 to 200 micrograms/kg/min) to increase CI and DO2 until all three goals were achieved simultaneously.
In group 2, target VO2 could never be reached despite the fact that 11 (65 percent) patients achieved target CI and DO2 simultaneously. In this group, lactate levels did not fall and 16 patients died. In contrast, in group 1, attainment of all goals was associated with a significant reduction (p < 0.05) in blood lactate levels, and all but one of these patients survived. The persistently raised lactate levels in group 2 were associated with significantly higher venous oxygen saturation (SvO2) and lower oxygen extraction ratio (OER); in these patients, SvO2 rose and OER fell in response to increases in DO2.
These results suggest that failure to increase VO2 was related predominantly to an inability of the tissues to extract or utilize oxygen rather than a failure to increase DO2. These findings support the hypothesis that in order to survive a critical illness, patients must achieve a high level of VO2. An inability to do so is reflected in persistently elevated blood lactate levels and an extremely poor prognosis.
评估针对一组异质性危重病患者旨在实现超常心脏和氧输送变量（心脏指数[CI]＞4.5L/（min·m²）、氧输送[DO₂]＞600ml/（min·m²）以及氧消耗[VO₂]＞170ml/（min·m²））的治疗反应，并评估其与预后的关系。
患者被回顾性地分为两组。第1组（n = 15）在最初24小时内同时实现了CI、DO₂和VO₂的超常值。第2组（n = 17）在任何时间点都未能同时实现这些目标。
一所教学医院和一所地区综合医院的普通重症监护病房。
前瞻性研究了32名有发生多器官功能衰竭风险的患者。
患者先进行容量扩充，必要时给予多巴酚丁胺（5至200微克/（千克·分钟））以增加CI和DO₂，直至同时实现所有三个目标。
在第2组中，尽管11名（65%）患者同时实现了目标CI和DO₂，但目标VO₂从未达到。在该组中，乳酸水平未下降，16名患者死亡。相比之下，在第1组中，所有目标的实现与血乳酸水平显著降低（p＜0.05）相关，且除1名患者外所有患者存活。第2组中持续升高的乳酸水平与显著更高的静脉血氧饱和度（SvO₂）和更低的氧摄取率（OER）相关；在这些患者中，SvO₂随DO₂增加而升高，OER随DO₂增加而降低。
这些结果表明，VO₂未能增加主要与组织无法摄取或利用氧有关，而非未能增加DO₂。这些发现支持了以下假设，即危重病患者为了存活必须达到高水平的VO₂。无法做到这一点表现为血乳酸水平持续升高和预后极差。
