CORONARY HEMODYNAMICS AND MYOCARDIAL-METABOLISM OF LACTATE, FREE FATTY-ACIDS, GLUCOSE, AND KETONES IN PATIENTS WITH SEPTIC SHOCK
CORONARY HEMODYNAMICS AND MYOCARDIAL-METABOLISM OF LACTATE, FREE FATTY-ACIDS, GLUCOSE, AND KETONES IN PATIENTS WITH SEPTIC SHOCK
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DOI：
10.1161/01.cir.75.3.533
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发表时间：
1987-03-01
期刊：
影响因子：
37.8
通讯作者：
RAICHVARG, D
中科院分区：
文献类型：
--
作者：
DHAINAUT, JF;HUYGHEBAERT, MF;RAICHVARG, D
为了研究感染性休克期间冠状动脉循环和心肌代谢的紊乱，我们检测了40例感染性休克患者和13例对照患者的冠状静脉窦血流和心肌基质提取。本研究排除了患有冠状动脉疾病的患者。脓毒症患者的总体血流动力学模式的特点是较低的每搏输出量，尽管心脏指数升高。冠状静脉窦血流量高（187 . ±. 47对130 +-。21 ml/min（对照组，p <0.001），这是由于显著的冠状血管扩张，尤其是在死亡者亚组中。与对照组相比，感染性休克患者的心肌乳酸摄取升高，而游离脂肪酸、葡萄糖和酮体摄取减少。这些发现在非幸存者中尤为突出。以氧当量表示，脓毒症患者中作为心肌能量来源的游离脂肪酸的贡献明显减少（12% vs对照组的54%，p <0.005），而乳酸的贡献增加（36% vs 12%，p <0.01）。观察到的心肌基质提取的变化与测量的心肌耗氧量和从常用外源性基质化学计算的耗氧量之间的差异有关;在所有感染性休克患者中，41%的心肌耗氧量不能通过使用从冠状循环提取的常用基质来解释。这些数据表明，心肌利用的内源性底物可能会解释这种差异，这表明，“强制性”利用内源性能源可能是基础进行性心脏参与感染性休克。
To investigate disturbances in the coronary circulation and myocardial metabolism during septic shock, we examined coronary sinus blood flow and myocardial substrate extraction in 40 patients with septic shock and 13 control patients. Patients with coronary artery disease were excluded from this study. The global hemodynamic pattern of the septic patients was characterized by a lower stroke volume, despite an elevated cardiac index. Coronary sinus blood flow was high (187 .+-. 47 vs 130 .+-. 21 ml/min the control group, p < .001) due to marked coronary vasodilation, especially in the subgroup of nonsurvivors. In contrast to the control group, myocardial lactate uptake was elevated, while that of free fatty acids, glucose, and ketone bodies was diminished in patients with septic shock. These findings were especially prominent in the nonsurivors. Expressed as oxygen eqivalents, the contribution of free fatty acids as an energy source of the myocardium was markedly diminished in septic patients (12% vs 54% in the control group, p < .005), while that of lactate was increased (36% vs 12%, p < .01). The observed shift in myocardial substrate extraction was associated with a discrepancy between measured myocardial oxygen consumption and that calculated chemically from commonly available exogenous substrates; 41% of myocardial oxygen consumption was not explained by the utilization of commonly available substrates extracted from coronary circulation in all patients with septic shock. These data indicate that myocardial utilization of endogenous substrates may probably account for this discrepancy, suggesting that a "mandatory" utilization of endogenous energy sources might underlie progressive cardiac involvement in septic shock.