Myocardial depression in sepsis: From pathogenesis to clinical manifestations and treatment
Myocardial depression in sepsis: From pathogenesis to clinical manifestations and treatment
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DOI：
10.1016/j.jcrc.2014.03.028
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发表时间：
2014-08-01
影响因子：
3.7
通讯作者：
Scolletta, Sabino
中科院分区：
文献类型：
--
作者：
Antonucci, Elio;Fiaccadori, Enrico;Scolletta, Sabino
心血管系统在脓毒症中起关键作用，脓毒症心肌抑制是与发病率和死亡率增加相关的常见发现。脓毒症期间的心肌抑制尚未明确定义，但它可能最好描述为心脏左右两侧的整体（收缩和舒张）功能障碍。脓毒性心肌抑制的发病机制涉及全身（血流动力学）因素和遗传、分子、代谢和结构改变的复杂混合。肺动脉导管插入术和现代超声多普勒技术是重要的诊断工具。对于脓毒性心肌抑制没有特异性治疗方法，治疗的基础是控制潜在的感染过程（充分的抗生素治疗，清除感染源）和血流动力学稳定（液体，血管加压剂和正性肌力药物）。本文就脓毒症心肌抑制的发病机制、诊断和治疗作一综述。需要更多的研究来提高脓毒性心肌功能障碍的诊断和确定治疗靶点。(C)2014爱思唯尔公司All rights reserved.
The cardiovascular system plays a key role in sepsis, and septic myocardial depression is a common finding associated with increased morbidity and mortality. Myocardial depression during sepsis is not clearly defined, but it can perhaps be best described as a global (systolic and diastolic) dysfunction of both the left and right sides of the heart. The pathogenesis of septic myocardial depression involves a complex mix of systemic (hemodynamic) factors and genetic, molecular, metabolic, and structural alterations. Pulmonary artery catheterization and modern echo-Doppler techniques are important diagnostic tools in this setting. There are no specific therapies for septic myocardial depression, and the cornerstone of management is control of the underlying infectious process (adequate antibiotic therapy, removal of the source) and hemodynamic stabilization (fluids, vasopressor and inotropic agents). In this review, we will summarize the pathogenesis, diagnosis, and treatment of myocardial depression in sepsis. Additional studies are needed in order to improve diagnosis and identify therapeutic targets in septic myocardial dysfunction. (C) 2014 Elsevier Inc. All rights reserved.