LEFT-VENTRICULAR PERFORMANCE IN SEPTIC SHOCK - REVERSIBLE SEGMENTAL AND GLOBAL ABNORMALITIES
LEFT-VENTRICULAR PERFORMANCE IN SEPTIC SHOCK - REVERSIBLE SEGMENTAL AND GLOBAL ABNORMALITIES
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DOI：
10.1016/0002-8703(85)90163-2
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发表时间：
1985-01-01
影响因子：
4.8
通讯作者：
MURATA, GH
中科院分区：
文献类型：
--
作者：
ELLRODT, AG;RIEDINGER, MS;MURATA, GH
左心室功能障碍与感染性休克的发病机制有关，但其自然史、病因及预后意义尚不清楚。对35例细菌培养证实的感染性休克患者进行了一系列放射性核素和血流动力学研究，以评估左心室功能。平均年龄（. ±. SD）为64 ± 0.01。18岁; 16名受试者为女性; 15名有既往心脏病。在第一项研究中，33名（94%）患者的左心室每搏作功指数降低; 19名（54%）患者的左心室射血分数< 0.48。22例（63%）患者有节段性室壁运动异常，4例有全身性室壁运动异常。常规血流动力学参数对预测左室射血分数降低或节段性异常无价值。有基础心脏病的患者节段性功能障碍的发生率（87%）远高于无基础心脏病的患者（45%; P = 0.016），但两组的左心室射血分数或左心室每搏作功指数无差异。左室舒张末期容积指数大的患者更常出现节段性异常和低射血分数。仅5例受试者的体循环血管阻力指数> 2580 dyn/s/cm-5/m2;体循环血管阻力指数与左心室射血分数之间的相关性较差。节段性异常和室壁运动正常者的平均冠状动脉灌注压无差异。因此，左心室射血分数降低和节段性功能障碍不能归因于容量不足、全身血管阻力指数增加或冠状动脉灌注压降低。22例存活患者的重复研究显示，1例患者的左室射血分数出现新的下降，5例患者的左室射血分数恢复正常，3例患者的节段性功能障碍逆转。存活者和非存活者的左心室射血分数、左心室每搏作功指数或节段性功能障碍的频率无差异。可逆性左心室功能不全在感染性休克中很常见，并且大多数是节段性的。
Left ventricular dysfunction has been implicated in the pathogenesis of septic shock, but little is known about its natural history, cause and prognostic significance. Left ventricular performance was assessed by serial radionuclide and hemodynamic studies in 35 patients with culture-proven septic shock. The mean age (.+-. SD) of the group was 64 .+-. 18 yr; 16 of the subjects were women; 15 had antecedent heart disease. On the first study, the left ventricular stroke work index was depressed in 33 (94%) patients; nineteen (54%) had a left ventricular ejection fraction < 0.48. Twenty-two (63%) of the patients had segmental and 4 had generalized wall motion abnormalities. Conventional hemodynamic parameters were of no value in predicting the patients who had a depressed left ventricular ejection fraction or segmental abnormalities. Patients with underlying heart disease had a much higher frequency (87%) of segmental dysfunction that those without underlying heart disease (45%; P = 0.016), but no differences were noted in the left ventricular ejection fraction or left ventricular stroke work index of these 2 groups. Segmental abnormalities and low ejection fractions were seen more often in patients with a large left ventricular end-diastolic volume index. Only 5 subjects had a systemic vascular resistance index > 2580 dyn/s/cm-5 per m2; the correlation between systemic vascular resistance index and left ventricular ejection fraction was poor. No difference was found in the mean coronary perfusion pressure of those with segmental abnormalities and those with normal wall motion. Thus, a depressed left ventricular ejection fraction and segmental dysfunction could not be attributed to volume depletion, to an increased systemic vascular resistance index or to a reduction in coronary perfusion pressure. Repeat studies in 22 surviving patients showed new depression of the left ventrcular ejection fraction in 1 patient, normalization of left ventricular ejection fraction in 5 and reversal of segmental dysfunction in 3. No differences were noted in the left ventricular ejection fraction, left ventricular stroke work index or frequency of segmental dysfunction between survivors and nonsurvivors. Reversible left ventricular dysfunction is common in septic shock and is most often segmental in nature.