Neviere R, Mathieu D, Chagnon J L, Lebleu N, Millien J P, Wattel F
Service de Réanimation Médicale et de Médecine hyperbare, Hôpital Calmette, Centre Hospitalier Régional Universitaire de Lille, France.
Am J Respir Crit Care Med. 1996 Jan;153(1):191-5. doi: 10.1164/ajrccm.153.1.8542115.
To compare skeletal muscle microvascular blood flow at rest and during reactive hyperemia in septic patients, a prospective, controlled trial was conducted on 16 patients with severe sepsis and a control group of 10 patients free of infection in the intensive care unit of a university hospital. Systemic hemodynamics, whole-body oxygen transport, and skeletal muscle microvascular blood flow at rest and during reactive hyperemia were measured. Reactive hyperemia was produced by arrest of leg blood flow with a pneumatic cuff; on completion of the 3 min ischemic phase the occluding cuff was rapidly deflated to 0. Hemodynamic and oxygen-derived variables were determined invasively. Skeletal muscle microvascular blood flow data were obtained using a laser Doppler flowmetry technique and values expressed in millivolts. Whole-body oxygen delivery in septic patients was increased compared with control subjects. Resting skeletal muscle blood flow was decreased in septic patients compared with control subjects (233 +/- 52 versus 394 +/- 93 mV; p < 0.05). Peak flow during reactive hyperemia was also decreased in septic patients compared with control subjects (380 +/- 13 versus 2,033 +/- 853 mV; p < 0.05). Cyclic variation in blood flow (vasomotion) was observed in control subjects but not in septic patients. Skeletal muscle microvascular perfusion is altered in patients with severe sepsis despite normal or elevated whole-body oxygen delivery. These microvascular abnormalities may further compromise tissue nutrient flow and may contribute to the development of organ failure in septic patients.
为比较脓毒症患者静息状态及反应性充血期间的骨骼肌微血管血流情况，在一所大学医院的重症监护病房，对16例严重脓毒症患者和10例无感染的对照组患者进行了一项前瞻性对照试验。测量了静息状态及反应性充血期间的全身血流动力学、全身氧输送和骨骼肌微血管血流。通过使用气动袖带阻断腿部血流来产生反应性充血；在3分钟缺血期结束时，将阻断袖带迅速放气至0。血流动力学和氧衍生变量通过有创方式测定。使用激光多普勒血流仪技术获取骨骼肌微血管血流数据，其值以毫伏表示。与对照组相比，脓毒症患者的全身氧输送增加。与对照组相比，脓毒症患者静息时的骨骼肌血流减少（233±52对394±93 mV；p<0.05）。与对照组相比，脓毒症患者反应性充血期间的峰值血流也减少（380±13对2033±853 mV；p<0.05）。在对照组中观察到血流的周期性变化（血管运动），但在脓毒症患者中未观察到。尽管全身氧输送正常或升高，但严重脓毒症患者的骨骼肌微血管灌注仍发生改变。这些微血管异常可能会进一步损害组织营养物质流动，并可能导致脓毒症患者发生器官衰竭。
