The Highs and Lows of Blood Pressure: Toward Meaningful Clinical Targets in Patients With Shock
The Highs and Lows of Blood Pressure: Toward Meaningful Clinical Targets in Patients With Shock
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DOI：
10.1097/ccm.0000000000000324
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发表时间：
2014-05-01
影响因子：
8.8
通讯作者：
Magder, Sheldon A.
中科院分区：
文献类型：
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作者：
Magder, Sheldon A.
目的：血压测量对于休克患者的治疗至关重要，但血压测量的生理基础和意义很复杂，而且往往不被很好地理解。本文分为两部分：第 1 部分讨论血压及其测量的机械和生理方面，第 2 部分讨论区域阻力变化在确定组织灌注和床边休克管理方法中的作用。数据来源和选择：本综述基于来自文本和实验研究的生理原理，阐明了一些关键原理。所表达的观点是作者对他人观点和自己观点的综合。 数据综合：动脉血压是局部血流的主要决定因素，通常被用作组织灌注的替代指标，但实际上，它并不是血流的一个不良指标。血压由心输出量（总流量）和总血管阻力决定。给定血压的流量分布取决于不同血管床阻力的相对值。如果已知这种阻力分布，这将是理想的治疗指南。不幸的是，在临床环境中无法评估局部阻力，因此我们只能以血压作为治疗指南。结论：本文讨论了这些要点的含义，并探讨了设计经验试验以确定休克患者适当血压目标时需要考虑的因素。即使经过充分研究的经验制定的指南可用，个体化患者管理可能仍然很重要，并且也讨论了这方面的方法。
Objective:Measurement of blood pressure is fundamental for the management of patients in shock, yet the physiological basis and meaning of blood pressure measurements are complex and often not well understood. This article is in two parts: part 1 deals with the mechanical and physiological aspects of blood pressure and its measurement and part 2 deals with the role of changes in regional resistances in the determination of tissue perfusion and bedside approaches to management of shock.Data Source and Selection:This review is based on physiological principles from texts and experimental studies which elucidate some of the key principles. The views expressed are the author's synthesis of the views of others and his own opinions.Data Synthesis:Arterial blood pressure is a major determinant of regional flow and is often used as a surrogate indicator of tissue perfusion, but in reality, it is a poor indicator of blood flow. Blood pressure is determined by cardiac output (total flow) and total vascular resistance. Distribution of flow for a given blood pressure is dependent on the relative values of resistances in different vascular beds. If this distribution of resistances were known, this would be the ideal guide to therapy. Unfortunately, regional resistances cannot be assessed in the clinical setting, and so we are left with blood pressure as a guide to therapy.Conclusions:This article discusses the implications of these points and explores factors that need to be taken into account when designing empiric trials to determine appropriate blood pressure targets for patients in shock. Even if well-studied empirically developed guidelines become available, it likely still will be important to individualize patient management and approaches for this are discussed too.