The microcirculation is the motor of sepsis.
The microcirculation is the motor of sepsis.
复制标题
DOI：
10.1186/cc3753
复制
发表时间：
2005
期刊：
影响因子：
--
通讯作者：
Ince C
中科院分区：
文献类型：
--
作者：
Ince C
由微循环功能障碍和线粒体抑制引起的局部组织窘迫是脓毒症和休克的基础，尽管全身氧输送变量得到纠正，但局部缺氧和氧提取不足仍然存在。我们称这种情况为微循环和线粒体窘迫综合征（MMDS）。正交偏振光谱成像允许在人体内部器官的微循环的第一个临床观察，并确定了微循环异常的关键作用，在定义脓毒症的严重程度，一个条件，不揭示全身血流动力学或氧衍生的变量。最近，舌下侧流暗场（SDF）成像已被引入，允许更详细地观察微循环。需要微循环募集以确保足够的微循环灌注和随后的组织细胞的氧合。在脓毒症中，炎症诱导的自身调节功能障碍持续存在，并且氧气需求与供应不匹配，可以通过减少病理性分流、促进微循环灌注、支持泵功能以及控制血液流变学和凝血来募集微循环。MMDS后的复苏必须包括低氧分流微循环单位的集中募集和/或线粒体的复苏。成功挽救微循环需要多种药物的联合。单一化合物，如活化蛋白C，它作用于多个途径，可以预期是有益的，在挽救败血症的微循环。
Regional tissue distress caused by microcirculatory dysfunction and mitochondrial depression underlies the condition in sepsis and shock where, despite correction of systemic oxygen delivery variables, regional hypoxia and oxygen extraction deficit persist. We have termed this condition microcirculatory and mitochondrial distress syndrome (MMDS). Orthogonal polarization spectral imaging allowed the first clinical observation of the microcirculation in human internal organs, and has identified the pivotal role of microcirculatory abnormalities in defining the severity of sepsis, a condition not revealed by systemic hemodynamic or oxygen-derived variables. Recently, sublingual sidestream dark-field (SDF) imaging has been introduced, allowing observation of the microcirculation in even greater detail. Microcirculatory recruitment is needed to ensure adequate microcirculatory perfusion and the oxygenation of tissue cells that follows. In sepsis, where inflammation-induced autoregulatory dysfunction persists and oxygen need is not matched by supply, the microcirculation can be recruited by reducing pathological shunting, promoting microcirculatory perfusion, supporting pump function, and controlling hemorheology and coagulation. Resuscitation following MMDS must include focused recruitment of hypoxic-shunted microcirculatory units and/or resuscitation of the mitochondria. A combination of agents is required for successful rescue of the microcirculation. Single compounds such as activated protein C, which acts on multiple pathways, can be expected to be beneficial in rescuing the microcirculation in sepsis.
登录
查看更多内容
DOI：
10.1186/cc2353
发表时间：
2003-10
期刊：
Critical care (London, England)
影响因子：
--
作者：
Bateman RM;Sharpe MD;Ellis CG
通讯作者：
Ellis CG
影响因子：
3.3
作者：
Fink, Mitchell P
通讯作者：
Fink, Mitchell P
DOI：
10.1152/ajpheart.00311.2002
发表时间：
2003-02-01
影响因子：
4.8
作者：
Cerwinka, WH;Cooper, D;Granger, DN
通讯作者：
Granger, DN
DOI：
10.1164/rccm.200109-016oc
发表时间：
2002-07-01
影响因子：
24.7
作者：
De Backer, D;Creteur, J;Vincent, JL
通讯作者：
Vincent, JL
影响因子：
82.9
作者：
Cosby, K;Partovi, KS;Gladwin, MT
通讯作者：
Gladwin, MT