Smith S M, Padayachee S, Modaresi K B, Smithies M N, Bihari D J
Department of Intensive Care, Guy's Hospital, London, England.
J Crit Care. 1998 Sep;13(3):104-9. doi: 10.1016/s0883-9441(98)90013-2.
In patients with septic shock, the cardiac index is often increased. Maldistribution of blood flow and regional hypoperfusion has been implicated as a key factor in the pathogenesis of organ dysfunction in these patients. We have investigated the relationship between cerebral blood flow and cardiac index in patients with septic shock.
We used Doppler ultrasound techniques to investigate limb and carotid blood flow in 15 patients with septic shock and 9 nonseptic controls.
In the nonseptic control patients, common femoral and brachial blood flow were proportional to cardiac index (r=0.73 and 0.76; P=.038 and .017, respectively) reflecting a protective redistribution of flow to more vital organs. However, this relationship was absent in patients with septic shock (r=0.23 and 0.21). Furthermore, in the septic patients but not the nonseptic controls, cerebral blood flow was correlated with the cardiac index (r=0.66, P < .05 vs r=-0.36, NS in nonseptic controls). Carotid flow was independent of mean arterial pressure, PaCO2 and PaO2 in patients with septic shock.
These data are consistent with a loss of autoregulation of cerebral blood flow and a change in the control of limb blood flow in humans with septic shock.
在感染性休克患者中，心脏指数常常升高。血流分布不均和局部灌注不足被认为是这些患者器官功能障碍发病机制中的关键因素。我们研究了感染性休克患者脑血流量与心脏指数之间的关系。
我们使用多普勒超声技术研究了15例感染性休克患者和9例非感染性对照者的肢体和颈动脉血流。
在非感染性对照患者中，股总动脉和肱动脉血流与心脏指数成比例（r分别为0.73和0.76；P分别为0.038和0.017），这反映了血流向更重要器官的保护性重新分布。然而，在感染性休克患者中这种关系并不存在（r分别为0.23和0.21）。此外，在感染性休克患者而非非感染性对照者中，脑血流量与心脏指数相关（r = 0.66，P <.05；非感染性对照者r = -0.36，无显著性差异）。感染性休克患者的颈动脉血流独立于平均动脉压、动脉血二氧化碳分压和动脉血氧分压。
这些数据与感染性休克患者脑血流量自动调节丧失以及肢体血流控制改变相一致。
