Metabolism modulators in sepsis: Propranolol
Metabolism modulators in sepsis: Propranolol
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DOI：
10.1097/01.ccm.0000278599.30298.80
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发表时间：
2007-09-01
影响因子：
8.8
通讯作者：
Herndon, David N.
中科院分区：
文献类型：
--
作者：
Norbury, William B.;Jeschke, Marc G.;Herndon, David N.
脓毒症伴随着儿茶酚胺表达的大幅增加，导致脂质和葡萄糖的代谢、心血管输出量的变化、免疫调节作用和蛋白质代谢的变化，所有这些都将身体推入分解代谢状态。 β-肾上腺素受体控制的对压力和脓毒症的有害反应已有充分记录。因此，在这种情况下使用普萘洛尔似乎是合适的。在压力和感染发作期间使用β-肾上腺素受体阻断剂存在赞成和反对的争论。在大多数情况下，脓毒症本身的定义是临床定义。有关于脓毒症（存在严重感染时的全身炎症反应综合征 [SIRS]）诊断的指南。然而，当 SIRS 的原因不是感染时，例如，对于烧伤患者来说，以更积极的方式应对应激反应是否不可能，而且实际上更可取？ SIRS 对身体的影响是多种多样的，许多精彩评论已经对其进行了定义和说明。败血症对身体的影响也已在世界文献中讨论过，但超出了本文的范围。在本文中，我们试图证明脓毒症（SIRS 加感染）对全身代谢的影响，概述这些变化的介质，然后展示普萘洛尔减弱所见变化的能力。 （Crit Care Med 2007；35[增刊]：S616-S620）
Sepsis is accompanied by an enormous increase in catecholamine expression, leading to metabolism of lipids and glucose, changes in cardiovascular output, immunomodulatory effects, and changes in protein metabolism, all of which push the body into a catabolic state. Deleterious beta-adrenoceptor controlled responses to stress and sepsis are well documented; therefore, it would seem appropriate to use propranolol under such circumstances. There are arguments both for and against the use of beta-adrenoceptor blockade during episodes of stress and infection. The definition of sepsis itself is a clinical one in most cases. There are guidelines concerning the diagnosis of sepsis (systemic inflammatory response syndrome [SIRS] in the presence of significant infection). However, when the cause of SIRS is not infection, for example, in burn patients, is it not possible, and indeed preferable, to tackle the stress response in a more aggressive fashion? The effects of SIRS on the body are myriad and have been defined and illustrated in many fine reviews. The effects of sepsis on the body, as well, have been discussed in the world literature and are beyond the scope of this article. In this article we attempt to demonstrate the effects of sepsis (SIRS plus infection) on whole body metabolism, outline the mediators of these changes, and then show the ability of propranolol to attenuate the changes seen. (Crit Care Med 2007; 35[Suppl.]: S616-S620)