Meier-Hellmann A, Specht M, Hannemann L, Hassel H, Bredle D L, Reinhart K
Department of Anesthesia and Critical Care Medicine, Friedrich Schiller University Jena, Germany.
Intensive Care Med. 1996 Dec;22(12):1354-9. doi: 10.1007/BF01709551.
To assess global and splanchnic blood flow and oxygen transport in patients with sepsis with and without norepinephrine treatment.
Prospective, clinical study.
University hospital intensive care unit.
A convenience sample of 15 septic shock patients treated with norepinephrine and 13 patients with severe sepsis who did not receive norepinephrine.
There were no differences between the two groups in global haemodynamics and oxygen transport. Splanchnic blood flow and oxygen delivery (splanchnic DO2 303 +/- 43 ml/min per m2) and consumption (splanchnic VO2 100 +/- 13 ml/min per m2) were much higher in the septic shock group compared with the severe sepsis group (splanchnic DO2 175 +/- 19 ml/min per m2, splanchnic VO2 61 +/- 6 ml/min per m2). Gastric mucosal pH was subnormal in both groups (septic shock 7.29 +/- 0.02, severe sepsis 7.25 +/- 0.02) with no significant difference. No significant differences between groups were detected in lactate values.
These data confirm a redistribution of blood flow to the splanchnic region in sepsis that is even more pronounced in patients with septic shock requiring norepinephrine. However, subnormal gastric mucosal pH suggested inadequate oxygenation in parts of the splanchnic region due to factors other than splanchnic hypoperfusion. Progress in this area will depend on techniques that address not only total splanchnic blood flow, but also inter-organ flow distribution, intra-organ distribution, and other microcirculatory or metabolic malfunctions.
评估接受和未接受去甲肾上腺素治疗的脓毒症患者的全身和内脏血流及氧输送情况。
前瞻性临床研究。
大学医院重症监护病房。
选取15例接受去甲肾上腺素治疗的感染性休克患者和13例未接受去甲肾上腺素治疗的严重脓毒症患者作为便利样本。
两组在全身血流动力学和氧输送方面无差异。与严重脓毒症组相比，感染性休克组的内脏血流、氧输送（内脏DO2为303±43 ml/（min·m²））和氧消耗（内脏VO2为100±13 ml/（min·m²））明显更高（严重脓毒症组内脏DO2为175±19 ml/（min·m²），内脏VO2为61±６ml/（min·m²））。两组患者胃黏膜pH均低于正常水平（感染性休克组为7.29±0.02，严重脓毒症组为7.25±0.02），无显著差异。两组间乳酸值无显著差异。
这些数据证实脓毒症患者存在血流重新分布至内脏区域的情况，在需要去甲肾上腺素治疗的感染性休克患者中更为明显。然而，胃黏膜pH低于正常水平提示内脏区域部分部位存在氧合不足，原因并非内脏灌注不足。该领域的进展将取决于不仅能解决内脏总血流量，还能解决器官间血流分布、器官内分布以及其他微循环或代谢功能障碍的技术。
