Pathophysiology of microcirculatory dysfunction and the pathogenesis of septic shock.
Pathophysiology of microcirculatory dysfunction and the pathogenesis of septic shock.
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DOI：
10.4161/viru.26482
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发表时间：
2014-01-01
期刊：
影响因子：
5.2
通讯作者：
Vincent JL
中科院分区：
文献类型：
--
作者：
De Backer D;Orbegozo Cortes D;Donadello K;Vincent JL
多项实验和人体试验表明，脓毒症的微循环改变是常见的。在这篇综述中，我们讨论了它们的发展过程中可能涉及的各种机制以及这些改变的影响。内皮功能障碍、细胞间通讯障碍、糖基化改变、白细胞和血小板的黏附和滚动以及红细胞变形性改变是这些改变发生的主要机制。微循环改变增加了氧的扩散距离，由于脓毒症微循环灌流的异质性，可能会促进组织缺氧区附近组织缺氧区的发展。微血管改变的严重程度与器官功能障碍和死亡率有关。在这个阶段，针对微循环的治疗方法仍在研究中。
Multiple experimental and human trials have shown that microcirculatory alterations are frequent in sepsis. In this review, we discuss the various mechanisms that are potentially involved in their development and the implications of these alterations. Endothelial dysfunction, impaired inter-cell communication, altered glycocalyx, adhesion and rolling of white blood cells and platelets, and altered red blood cell deformability are the main mechanisms involved in the development of these alterations. Microcirculatory alterations increase the diffusion distance for oxygen and, due to the heterogeneity of microcirculatory perfusion in sepsis, may promote development of areas of tissue hypoxia in close vicinity to well-oxygenated zones. The severity of microvascular alterations is associated with organ dysfunction and mortality. At this stage, therapies to specifically target the microcirculation are still being investigated.