Mesenteric hemodynamic response to circulatory shock.
Mesenteric hemodynamic response to circulatory shock.
复制标题
DOI：
10.1097/00075198-200304000-00008
复制
发表时间：
2003-04-01
影响因子：
3.3
通讯作者：
Bulkley, Gregory B
中科院分区：
文献类型：
--
作者：
Ceppa, Eugene P;Fuh, Katherine C;Bulkley, Gregory B
审查目的：肠系膜对循环休克的血流动力学反应是实质性的和不对称的;血管收缩反应不成比例地影响肠系膜器官。心输出量通过肠系膜静脉的血管收缩而部分维持，而无需营养物质流向肠系膜器官，导致高达30%的循环血量“自体输血”进入体循环。出血性或心源性休克也会导致灌注压降低，促使肠系膜小动脉的选择性血管收缩，以维持重要器官的灌注压，这里是选择性牺牲肠系膜器官。脓毒性休克可能与肠系膜血流量增加或减少有关，但其特征是耗氧量增加，超过了肠系膜供氧的能力。概要：对任何这些情况的反应可能会导致出血性胃应激糜烂、小肠非闭塞性肠系膜缺血、缺血性结肠炎、缺血性肝炎、非结石性胆囊炎和/或缺血性胰腺炎。肠系膜器官的损伤也可引发全身炎症反应综合征，从而导致多器官功能衰竭。
PURPOSE OF REVIEW: The mesenteric hemodynamic response to circulatory shock is substantial and asymmetrical; the vasoconstrictive response disproportionately affects the mesenteric organs. The cardiac output is sustained partially, at no cost in nutrient flow to the mesenteric organs, by vasoconstriction of the mesenteric veins, resulting in the "autotransfusion" of up to 30% of the circulating blood volume into the systemic circulation.RECENT FINDINGS: Hemorrhagic or cardiogenic shock also results in decreased perfusion pressure, prompting selective vasoconstriction of the mesenteric arterioles to maintain perfusion pressure of the vital organs, here at the selective expense of the mesenteric organs. Septic shock may be associated with increased or decreased mesenteric blood flow but is characterized by increased oxygen consumption, exceeding the capability of mesenteric oxygen delivery.SUMMARY: The response to any of these conditions can, variably and unpredictably, cause hemorrhagic gastric stress erosions, nonocclusive mesenteric ischemia of the small bowel, ischemic colitis, ischemic hepatitis, acalculous cholecystitis, and/or ischemic pancreatitis. Injury to the mesenteric organs can also initiate the systemic inflammatory response syndrome and, consequently, multiple organ failure.