Bacher A, Mayer N, Klimscha W, Oismüller C, Steltzer H, Hammerle A
Department of Anesthesiology and General Intensive Care, University of Vienna, Austria.
Crit Care Med. 1997 May;25(5):795-800. doi: 10.1097/00003246-199705000-00014.
To evaluate the effects of pentoxifylline on hemodynamics and systemic oxygenation in septic and nonseptic critically ill patients.
Prospective clinical investigation.
Intensive care unit (ICU) of a university hospital.
Nineteen critically ill patients were included in the study 1 to 4 days after their admission to the ICU. A systemic inflammatory response syndrome was present in 12 patients, fulfilling at least two of the American College of Chest Physicians/ Society of Critical Care Medicine Consensus Conference criteria. The other seven patients did not fulfill these criteria and were classified as nonseptic.
All patients were mechanically ventilated. The dosage of catecholamines was kept constant during the entire study period and at least during 15 mins before the start of the study. In both study groups, pulmonary and radial artery catheters were inserted and 5 mg/kg of pentoxifylline (diluted in 300 mL of physiologic saline) was intravenously administered over a period of 180 mins at a rate of 100 mL/hr.
Hemodynamic variables, oxygen transport (DO2), oxygen uptake (VO2), and oxygen extraction ratio were determined before pentoxifylline, after 2.5 mg/kg of pentoxifylline, after 5 mg/kg of pentoxifylline, and 60 mins after the termination of pentoxifylline. Repeated-measures analysis of variance and Mann-Whitney test were used for statistical analysis. At baseline, there were significant differences between the septic and the nonseptic groups in mean pulmonary arterial pressure (septic: 31 +/- 5 mm Hg; nonseptic: 26 +/- 7 mm Hg, p < .05), and pulmonary vascular resistance index (PVRI) (septic: 344 +/- 121 dyne.sec/ cm5.m2; nonseptic: 233 +/- 100 dyne.sec/cm5.m2, p < .05). In the septic group, significant increases in heart rate and cardiac index were observed. Systemic vascular resistance index and PVRI decreased. No significant changes in hemodynamic variables occurred in the nonseptic group. In both groups, DO2 and VO2 increased significantly, while oxygen extraction ratio remained unchanged.
The administration of pentoxifylline to septic patients results in a significant improvement in hemodynamic performance compared with critically ill nonseptic patients. The better hemodynamic state is accompanied by an increase in DO2 and VO2 with unchanged oxygen extraction ratio.
评估己酮可可碱对脓毒症和非脓毒症重症患者血流动力学及全身氧合的影响。
前瞻性临床研究。
一所大学医院的重症监护病房（ICU）。
19例重症患者在入住ICU后1至4天纳入研究。12例患者存在全身炎症反应综合征，至少符合美国胸科医师学会/危重病医学会共识会议标准中的两条。另外7例患者不符合这些标准，被归类为非脓毒症患者。
所有患者均接受机械通气。在整个研究期间，至少在研究开始前15分钟内，儿茶酚胺的剂量保持恒定。在两个研究组中，均插入肺动脉和桡动脉导管，并以100 mL/小时的速率在180分钟内静脉注射5 mg/kg己酮可可碱（稀释于300 mL生理盐水中）。
在注射己酮可可碱前、注射2.5 mg/kg己酮可可碱后、注射5 mg/kg己酮可可碱后以及注射结束后60分钟，测定血流动力学变量、氧输送（DO2）、氧摄取（VO2）和氧摄取率。采用重复测量方差分析和曼-惠特尼检验进行统计分析。基线时，脓毒症组和非脓毒症组在平均肺动脉压（脓毒症组：31±5 mmHg；非脓毒症组：26±7 mmHg，p<0.05）和肺血管阻力指数（PVRI）（脓毒症组：344±121达因·秒/cm5·m2；非脓毒症组：233±100达因·秒/cm5·m2，p<0.05）方面存在显著差异。在脓毒症组中，观察到心率和心脏指数显著增加。全身血管阻力指数和PVRI降低。非脓毒症组血流动力学变量无显著变化。在两组中，DO2和VO2均显著增加，而氧摄取率保持不变。
与重症非脓毒症患者相比，脓毒症患者使用己酮可可碱可显著改善血流动力学表现。更好的血流动力学状态伴随着DO2和VO2的增加，而氧摄取率不变。
