MALNUTRITION, SURGICAL SEPSIS, AND CARDIAC FUNCTION

心功能不全是外科重症监护中常见的问题 护理单位（SICU）。 它发生在败血症的情况下， 高代谢，经常需要药物、液体和呼吸机 支持. 心力衰竭也是多发性硬化症的常见组成部分。 系统器官衰竭（MSOF），90%的SICU死亡原因 患者 营养不良存在于SICU患者中， 慢性高代谢（MSOF）的主要表现。 两 败血症和营养不良可降低心室性能（Frank， Starling性能;功率输出）和体内收缩性 模型 这种心室功能的抑制通常是 对正性肌力药无效。 在临床环境中， 很难确定是否败血症，营养不良，或两者兼而有之 导致心肌功能下降 营养 在这些设置中通常使用支持。 急性的影响 营养支持对SICU患者心功能的影响 大部分未经研究，当用于 中度至重度营养不良。 本研究 将允许定量评估舒张和收缩压 仅在营养不良、败血症的情况下的心功能 单独，营养不良和败血症，而不是营养不良， 败血症 将采用慢性清醒犬模型， 超声测微法评估心脏收缩/舒张功能; 热量剥夺导致营养不良;盲肠梗死 诱发败血症 此外，急性营养不良的影响 对心室功能的TPN支持（TPN）将在 同样的四个国家。 药效学改变可能是由于 β受体功能障碍或内源性β受体激动剂的药代动力学改变 化学试剂，例如，儿茶酚胺，或施用的药物。 药物清除率和蛋白质结合与药物改变 在营养不良、脓毒症、器官衰竭 和营养支持。 药物动力学和β受体 功能将在相同的控制和实验中进行评价 作为改变心脏动力学的原因， 观察 所得见解将适用于临床 制定和制定新的药物和营养方案， SICU病人心脏功能改变的证据

Cardiac dysfunction is a common problem in the surgical intensive care unit (SICU). It occurs in settings of sepsis and hypermetabolism, frequently requiring drug, fluid and ventilator support. Cardiac failure is also a common component of multiple systems organ failure (MSOF), the cause of death in 90% of SICU patients. Malnutrition is present in SICU patients and is a primary manifestation of chronic hypermetabolism - MSOF. Both sepsis and malnutrition can depress ventricular performance (Frank- Starling performance; power output) and contractility in in-vivo models. This depression of ventricular function is frequently refractory to inotropic agents. In the clinical setting, it is difficult to identify whether sepsis, malnutrition, or both are responsible for the depression in myocardial function. Nutrition support is commonly used in these settings. The effects of acute nutrition support on cardiac function in these SICU settings is largely unstudied and it can cause sudden death when used in conditions of moderate to severe malnutrition. The present studies will allow the quantitative assessment of diastolic and systolic cardiac function under conditions of malnutrition alone, sepsis alone, malnutrition and sepsis, and neither malnutrition nor sepsis. A chronic, awake canine model will be employed, utilizing sonomicrometry to assess systolic/diastolic cardiac function; caloric deprivation to induce malnutrition; and cecal infarction to induce sepsis. In addition, the effects of acute nutrition support (TPN) on ventricular function will be determined in the same four states. The altered pharmacodynamics could be due to beta receptor malfunction or altered pharmacokinetics of endogenous chemical agents, e.g. catecholamines, or administered drugs. Altered drug clearance and protein binding with altered drug dynamics have been observed in malnutrition, sepsis, organ failure and with nutrition support. Drug kinetics and beta receptor function will be evaluated in the same control and experimental groups as a cause of the altered cardiac dynamics that are observed. The insight derived will be applicable in the clinical setting and in deriving new drug and nutrition regimens for support of the altered cardiac function in SICU patients.