Cerebrovascular reactivity to carbon dioxide in sepsis syndrome
Cerebrovascular reactivity to carbon dioxide in sepsis syndrome
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DOI：
10.1046/j.1365-2044.2003.29671.x
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发表时间：
2003-03-01
期刊：
影响因子：
10.7
通讯作者：
Mahajan, RP
中科院分区：
文献类型：
--
作者：
Bowie, RA;O'Connor, PJ;Mahajan, RP
脓毒症中的脑功能障碍在危重成人中很常见。然而，脓毒症对脑血流动力学的影响知之甚少。我们研究了12名镇静和通气的脓毒症患者，他们的脓毒症已经建立超过24小时。在正常碳酸血症、低碳酸血症（-1 kPa）和高碳酸血症（+1 kPa）下进行大脑中动脉血流速度的经颅多普勒测量。根据这些数据，计算脑血管对二氧化碳的反应性。还记录了指示疾病严重程度、全身心血管状态和结局的变量。我们发现脑血管对二氧化碳的反应性发生了显著变化。12名患者中只有3名患者的脑血管对二氧化碳的反应性在正常范围内; 7名患者的脑血管对二氧化碳的反应性降低，而2名患者的反应性升高。在这个小样本中，我们没有发现脑血管对二氧化碳的反应性改变与疾病严重程度、心血管状态或结局之间的任何相关趋势。这项研究表明，建立脓毒症深刻影响血管张力和反应性，不仅是体循环，但也脑血管。
Cerebral dysfunction in sepsis is common in critically ill adults. However, little is known of the effects of sepsis on cerebral haemodynamics. We studied 12 sedated and ventilated patients in whom sepsis had been established for > 24 h. Transcranial Doppler measurements of the middle cerebral artery flow velocity were made at normocapnia, then hypocapnia (-1 kPa) and hypercapnia (+1 kPa). From these data, cerebrovascular reactivity to carbon dioxide was calculated. Variables indicating disease severity, systemic cardiovascular status and outcome were also recorded. We found significant changes in cerebrovascular reactivity to carbon dioxide. Only three of 12 patients had a cerebrovascular reactivity to carbon dioxide in the normal range; seven patients had a reduced cerebrovascular reactivity to carbon dioxide, whereas in two patients it was raised. In this small sample, we could not find any trend of association between altered cerebrovascular reactivity to carbon dioxide and severity of illness, cardiovascular status or outcome. This study suggests that established sepsis profoundly affects the vascular tone and reactivity, not only of the systemic circulation, but also of the cerebral vasculature.