Rothhammer A
Institut für Anästhesiologie und Intensivmedizin am Leopoldina-Krankenhaus der Stadt Schweinfurt.
Anasthesiol Intensivmed Notfallmed Schmerzther. 1998 Jun;33 Suppl 2:S54-9. doi: 10.1055/s-2007-994878.
Continuous oxygen supply to the tissues is one of the many important factors in intensive care. However, as a basic requirement for the structure and function of higher developed organisms energy production by oxydative metabolism is of outstanding importance, because there is no significant storage of energy and anaerobic metabolism is insufficient. The determinants of oxygen supply--blood flow and oxygen content--are well known. The system stands out for its extensive ability to compensate imbalances. Nevertheless one has to bear in mind also rather trivial disturbances like insufficient respiration and hypovolemia. Absolute values of global parameters, however, provide no information on the oxygen supply of individual organs that are variably susceptible to hypoxia. Regional perfusion and tissue respiration are influenced by various factors. Together with systemic components the physiologic oxygen transport along the oxygen cascade follows demand. Regardless of their position on the oxygen cascade malfunctions of oxygenation impair first the function and eventually the structure of the tissues. An utilisation block on the cellular level can prevent sufficient energy production despite optimized oxygen supply, the damage of reperfusion can intensify the effects of hypoxia. Typical haemodynamic patterns follow the tissue hypoxia. For maintaining an equilibrium between oxygen demand and supply it is important that oxygen consumption is also influenced by numerous factors. Only when an imbalance between oxygen supply and demand--an oxygen debt--is realized at an early stage, the critically ill patient can be saved from irreversible damage. In the field of intensive care the frequently latent tissue hypoxia is often a result of the chronic oxygen debt of individual, particularly vulnerable organs. Considering those aspects the intestinal mucosa is particularly suited for the monitoring of tissue oxygenation in the critically ill patient.
持续向组织供氧是重症监护中的诸多重要因素之一。然而，作为高等生物结构和功能的基本要求，通过氧化代谢产生能量具有突出的重要性，因为能量没有显著的储存，且无氧代谢不足。氧供的决定因素——血流量和氧含量——是众所周知的。该系统以其广泛的补偿失衡能力而突出。然而，人们也必须牢记一些相当常见的干扰因素，如呼吸不足和血容量过低。然而，全局参数的绝对值并不能提供关于各个器官氧供的信息，这些器官对缺氧的易感性各不相同。局部灌注和组织呼吸受多种因素影响。与全身各组成部分一起，沿氧级联的生理性氧运输随需求而变化。无论在氧级联中的位置如何，氧合功能障碍首先会损害组织的功能，最终损害其结构。细胞水平的利用障碍可阻止在优化氧供的情况下产生足够的能量，再灌注损伤会加剧缺氧的影响。典型的血流动力学模式伴随组织缺氧出现。为维持氧供需之间的平衡，氧消耗也受多种因素影响这一点很重要。只有在早期认识到氧供需失衡——氧债，才能使重症患者免于不可逆转的损害。在重症监护领域，频繁出现的潜在组织缺氧往往是个体尤其是脆弱器官长期氧债的结果。考虑到这些方面，肠黏膜特别适合用于监测重症患者的组织氧合情况。
