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休克复苏:血流至上,氧流至优

杜微 王小亭 刘大为

杜微, 王小亭, 刘大为. 休克复苏:血流至上,氧流至优[J]. 协和医学杂志, 2022, 13(6): 915-920. doi: 10.12290/xhyxzz.2022-0441
引用本文: 杜微, 王小亭, 刘大为. 休克复苏:血流至上,氧流至优[J]. 协和医学杂志, 2022, 13(6): 915-920. doi: 10.12290/xhyxzz.2022-0441
DU Wei, WANG Xiaoting, LIU Dawei. In Shock Resuscitation, Blood Flow Should be Considered First, and Oxygen Flux Should be Optimized Second[J]. Medical Journal of Peking Union Medical College Hospital, 2022, 13(6): 915-920. doi: 10.12290/xhyxzz.2022-0441
Citation: DU Wei, WANG Xiaoting, LIU Dawei. In Shock Resuscitation, Blood Flow Should be Considered First, and Oxygen Flux Should be Optimized Second[J]. Medical Journal of Peking Union Medical College Hospital, 2022, 13(6): 915-920. doi: 10.12290/xhyxzz.2022-0441

休克复苏:血流至上,氧流至优

doi: 10.12290/xhyxzz.2022-0441
基金项目: 

中国医学科学院中央级公益性研究院所基本科研业务费专项资金 2020-RW320-001

详细信息
    通讯作者:

    刘大为, E-mail: dwliu98@163.com

  • 中图分类号: R441.9

In Shock Resuscitation, Blood Flow Should be Considered First, and Oxygen Flux Should be Optimized Second

Funds: 

The Non-profit Central Research Institute Fund of Chinese Academy of Medical Sciences 2020-RW320-001

More Information
  • 摘要: 人类对重症认知的重要里程碑是从对休克的血流动力学精细化理解开始。经过几十年的发展,血流动力学治疗理念更加完善,休克的治疗既有依托于指南的群体化治疗,又有具体到床旁每一位患者的个体化策略。血流的龙头效应早已深入人心,而血流中的氧流更是休克血流动力学复苏的目的性指标。本文对血流及血流中的氧流进行进一步追踪探讨,并将血流与氧流的影响因素、监测与复苏导向治疗进行拆分,提出基于血流-氧流的休克新分型,以期在器官化血流动力学治疗理念之下开启更精准的血流动力学治疗时代。
    作者贡献:杜微负责选题设计并撰写论文初稿; 王小亭负责论文修订; 刘大为终审定稿。
    利益冲突:所有作者均声明不存在利益冲突
  • 图  1  血流-氧流导向血流动力学治疗的休克分型

    HGB:血红蛋白; SaO2:动脉血氧饱和度

  • [1] Lamontagne F, Richards-Belle A, Thomas K, et al. Effect of Reduced Exposure to Vasopressors on 90-Day Mortality in Older Critically Ⅲ Patients With Vasodilatory Hypotension: A Randomized Clinical Trial[J]. JAMA, 2020, 323: 938-949. doi:  10.1001/jama.2020.0930
    [2] Hernández G, Ospina-Tascón GA, Damiani LP, et al. Effect of a Resuscitation Strategy Targeting Peripheral Perfusion Status vs Serum Lactate Levels on 28-Day Mortality Among Patients With Septic Shock: The ANDROMEDA-SHOCK Randomized Clinical Trial[J]. JAMA, 2019, 21: 654-664.
    [3] Massey MJ, Larochelle E, Najarro G, et al. The microcirculation image quality score: development and preliminary evaluation of a proposed approach to grading quality of image acquisition for bedside videomicroscopy[J]. J Crit Care, 2013, 28: 913-917. doi:  10.1016/j.jcrc.2013.06.015
    [4] De Backer D, Donadello K, Sakr Y, et al. Microcirculatory alterations in patients with severe sepsis: impact of time of assessment and relationship with outcome[J]. Crit Care Med, 2013, 41: 791-799. doi:  10.1097/CCM.0b013e3182742e8b
    [5] Ait-Oufella H, Lemoinne S, Boelle PY, et al. Mottling score predicts survival in septic shock[J]. Intensive Care Med, 2011, 37: 801-807. doi:  10.1007/s00134-011-2163-y
    [6] Ospina-Tascon G, Neves AP, Occhipinti G, et al. Effects of fluids on microvascular perfusion in patients with severe sepsis[J]. Intensive Care Med, 2010, 36: 949-955. doi:  10.1007/s00134-010-1843-3
    [7] Edul VS, Ince C, Navarro N, et al. Dissociation between sublingual and gut microcirculation in the response to a fluid challenge in postoperative patients with abdominal sepsis[J]. Ann Intensive Care, 2014, 4: 39. doi:  10.1186/s13613-014-0039-3
    [8] Aldecoa C, Llau JV, Nuvials X, et al. Role of albumin in the preservation of endothelial glycocalyx integrity and the microcirculation: a review[J]. Ann Intensive Care, 2020, 10: 85. doi:  10.1186/s13613-020-00697-1
    [9] Nascente A, Freitas F, Bakker J, et al. Microcirculation improvement after short-term infusion of vasopressin in septic shock is dependent on noradrenaline[J]. Clinics (Sao Paulo), 2017, 72: 750-757. doi:  10.6061/clinics/2017(12)06
    [10] Du W, Liu D, Long Y, et al. The β-Blocker Esmolol Restores the Vascular Waterfall Phenomenon After Acute Endotoxemia[J]. Crit Care Med, 2017, 45: e1247-e1253. doi:  10.1097/CCM.0000000000002721
    [11] Modun D, Krnic M, Vukovic J, et al. Plasma nitrite concentration decreases after hyperoxia-induced oxidative stress in healthy humans[J]. Clin Physiol Funct Imaging, 2012, 32: 404-408. doi:  10.1111/j.1475-097X.2012.01133.x
    [12] Helmerhorst H, de Wilde R, Lee DH, et al. Hemodynamic effects of short-term hyperoxia after coronary artery bypass grafting[J]. Ann Intensive Care, 2017, 7: 20. doi:  10.1186/s13613-017-0246-9
    [13] Wei HS, Kang H, Rasheed ID, et al. Erythrocytes Are Oxygen-Sensing Regulators of the Cerebral Microcirculation[J]. Neuron, 2016, 91: 851-862. doi:  10.1016/j.neuron.2016.07.016
    [14] Uchimido R, Schmidt EP, Shapiro NI. The glycocalyx: a novel diagnostic and therapeutic target in sepsis[J]. Crit Care, 2019, 23: 16. doi:  10.1186/s13054-018-2292-6
    [15] Preau S, Vodovar D, Jung B, et al. Energetic dysfunction in sepsis: a narrative review[J]. Ann Intensive Care, 2021, 11: 104. doi:  10.1186/s13613-021-00893-7
    [16] Scheuzger J, Zehnder A, Meier V, et al. Sublingual microcirculation does not reflect red blood cell transfusion thresholds in the intensive care unit-a prospective observational study in the intensive care unit[J]. Crit Care, 2020, 24: 18. doi:  10.1186/s13054-020-2728-7
    [17] Bateman RM, Tokunaga C, Kareco T, et al. Myocardial hypoxia-inducible HIF-1alpha, VEGF, and GLUT1 gene expression is associated with microvascular and ICAM-1 heterogeneity during endotoxemia[J]. Am J Physiol Heart Circ Physiol, 2007, 293: H448-H456.
    [18] Ospina-Tascón GA, García Marin AF, Echeverri GJ, et al. Effects of dobutamine on intestinal microvascular blood flow heterogeneity and O(2) extraction during septic shock[J]. J Appl Physiol (1985), 2017, 122: 1406-1417. doi:  10.1152/japplphysiol.00886.2016
    [19] Kirkman MA, Smith M. Brain Oxygenation Monitoring[J]. Anesthesiol Clin, 2016, 34: 537-556. doi:  10.1016/j.anclin.2016.04.007
    [20] Römers LH, Bakker C, Dollée N, et al. Cutaneous Mitochondrial PO2, but Not Tissue Oxygen Saturation, Is an Early Indicator of the Physiologic Limit of Hemodilution in the Pig[J]. Anesthesiology, 2016, 125: 124-132. doi:  10.1097/ALN.0000000000001156
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出版历程
  • 收稿日期:  2022-08-10
  • 录用日期:  2022-10-10
  • 网络出版日期:  2022-10-26
  • 刊出日期:  2022-11-30

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