Microcirculatory oxygenation and shunting in sepsis and shock
Microcirculatory oxygenation and shunting in sepsis and shock
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DOI：
10.1097/00003246-199907000-00031
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发表时间：
1999-07-01
影响因子：
8.8
通讯作者：
Sinaasappel, M
中科院分区：
文献类型：
--
作者：
Ince, C;Sinaasappel, M
目的：回顾用于评估组织氧合决定因素的光学光谱技术，并评估脓毒症中氧通路的紊乱可以通过部分微循环功能分流增强来解释的观点。数据来源：对以往研究和文献的实验数据进行分析。研究选择：所选数据涉及a）脓毒症中的细胞窘迫是否由组织缺氧或代谢途径紊乱引起，B）用于研究微循环氧合的光学光谱技术，和c）低氧血症和败血症微循环分流的潜在机制。研究综合：尽管复苏的氧源变量，局部组织缺氧的迹象持续败血症。这种情况的潜在机制预计与微循环中的氧通路有关。光学光谱技术为这些机制提供了新的见解。这些包括红细胞的血红蛋白饱和度的吸收光谱，减少烟酰胺腺嘌呤二核苷酸荧光组织线粒体生物能量学，和钯卟啉磷光微血管Po-2。还原型烟酰胺腺嘌呤二核苷酸视频荧光研究显示了缺氧的异质性。猪肠道微血管Po-2的测量表明，在出血和内毒素血症期间，微血管Po-2和静脉Po-2之间的Po-2间隙的发展，脓毒症中的间隙大于出血。据推测，这种差异是由增强分流的微循环存在于sepsis. Conclusions：微循环窘迫可能形成脓毒症的进展中的最早阶段之一，多器官功能衰竭，和分流的微循环可能是一个重要的促成因素，这种发展。为了评估微循环窘迫的严重程度和复苏策略的有效性，需要开发针对微循环的新临床技术。预计光谱学将在开发此类工具方面发挥重要作用。
Objective: To review optical spectroscopic techniques for assessment of the determinants of tissue oxygenation and to evaluate the notion that the disturbances in oxygen pathways in sepsis can be accounted for by enhanced functional shunting of parts of the microcirculation.Data Resources: Experimental data from previous research and the literature were analyzed.Study Selection:The data selected pertained to a) whether cellular distress in sepsis is caused by tissue hypoxia or disturbed metabolic pathways, b) optical spectroscopic techniques used to study microcirculatory oxygenation, and c) possible mechanisms underlying shunting of the microcirculation in hypoxemia and sepsis.Study Synthesis: Despite resuscitation of oxygen-derived variables, signs of regional tissue hypoxia persist in sepsis. The mechanisms underlying this condition are expected to be associated with oxygen pathways in the microcirculation. Optical spectroscopic techniques are providing new insights into these mechanisms. These include absorption spectroscopy for hemoglobin saturation of erythrocytes, reduced nicotinamide adenine dinucleotide fluorescence for tissue mitochondrial bioenergetics, and palladium-porphyrin phosphorescence for microvascular Po-2. Reduced nicotinamide adenine dinucleotide videofluorescence studies have shown the heterogeneous nature of hypoxia. Measurement of gut microvascular Po-2 in pigs has shown the development of a Po-2 gap between microvascular Po-2 and venous Po-2 during hemorrhage and endotoxemia, with a larger gap occurring in sepsis than in hemorrhage. It is hypothesized that this difference is caused by the enhanced shunting of the microcirculation present in sepsis.Conclusions: Microcirculatory distress may form one of the earliest stages in the progress of sepsis to multiple organ failure, and shunting of the microcirculation may be an important contributing factor to this development. To evaluate the severity of microcirculatory distress and the effectiveness of resuscitation strategies, new clinical technologies aimed at the microcirculation will need to be developed. It is anticipated that optical spectroscopy will play a major role in the development of such tools.