切换至 "中华医学电子期刊资源库"

第五届中国出版政府奖音像电子网络出版物奖提名奖

中国科技核心期刊

中国科学引文数据库(CSCD)来源期刊

中华重症医学电子杂志 ›› 2020, Vol. 06 ›› Issue (02) : 128 -131. doi: 10.3877/cma.j.issn.2096-1537.2020.02.004

所属专题: 重症医学 文献

专题笔谈

脓毒症性心肌病的血管活性药物选择
刘一娜1, 马晓春1,()   
  1. 1. 110001 辽宁沈阳,中国医科大学附属第一医院重症医学科
  • 收稿日期:2019-12-24 出版日期:2020-05-28
  • 通信作者: 马晓春

Selection of vasoactive agents in septic cardiomyopathy

Yina Liu1, Xiaochun Ma1,()   

  1. 1. Department of Critical Care Medicine, the First Affiliated Hospital of China Medical University, Shenyang 110001, China
  • Received:2019-12-24 Published:2020-05-28
  • Corresponding author: Xiaochun Ma
  • About author:
    Corresponding author: Ma Xiaochun, Email:
引用本文:

刘一娜, 马晓春. 脓毒症性心肌病的血管活性药物选择[J]. 中华重症医学电子杂志, 2020, 06(02): 128-131.

Yina Liu, Xiaochun Ma. Selection of vasoactive agents in septic cardiomyopathy[J]. Chinese Journal of Critical Care & Intensive Care Medicine(Electronic Edition), 2020, 06(02): 128-131.

脓毒症性心肌病是脓毒症导致的急性心功能障碍综合征,与冠状动脉阻塞所致缺血无明显关联,其以心室扩张、心肌收缩减弱、心功能损害具有可逆性为特征,诊断和治疗措施尚不明确。一般认为脓毒症性心肌病的治疗策略与未合并心肌病的脓毒症并无明显不同,血管活性药物的选择可参照脓毒症、感染性休克的临床研究及指南推荐意见实施,个体化治疗策略还有待高质量的临床研究数据提供。

Septic cardiomyopathy is an acute syndrome of cardiac dysfunction that is unrelated to cardiac ischemia in patients with sepsis. It is characterized by ventricular dilation, myocardial contraction weakening, and reversible cardiac dysfunction. There have been no standards for the diagnosis and therapy of septic cardiomyopathy, and the treatment strategy currently used for septic cardiomyopathy is the same as that for sepsis without cardiomyopathy. When selecting vasoactive agents, the recommendations from sepsis guidelines should be taken into account. Further clinical research of individualized treatment for septic cardiomyopathy is necessary.

1
Beesley SJ, Weber G, Sarge T, et al. Septic Cardiomyopathy. Critical care medicine [J]. 2018, 46(4): 625-634.
2
Sato R, Kuriyama A, Takada T, et al. Prevalence and risk factors of sepsis-induced cardiomyopathy: A retrospective cohort study[J]. Medicine, 2016, 95(39): e5031.
3
Jeong HS, Lee TH, Bang CH, et al. Risk factors and outcomes of sepsis-induced myocardial dysfunction and stress-induced cardiomyopathy in sepsis or septic shock: A comparative retrospective study[J]. Medicine, 2018, 97(13): e0263.
4
Vieillard-Baron A, Caille V, Charron C, et al. Actual incidence of global left ventricular hypokinesia in adult septic shock[J]. Critical Care Medicine, 2008, 36(6): 1701-1706.
5
Kakihana Y, Ito T, Nakahara M, et al. Sepsis-induced myocardial dysfunction: pathophysiology and management[J]. J Intensive Care. 2016, 4: 22.
6
Huang SJ, Nalos M, McLean AS. Is early ventricular dysfunction or dilatation associated with lower mortality rate in adult severe sepsis and septic shock? A meta-analysis[J]. Critical Care, 2013, 17(3): R96.
7
Sato R, Nasu M. A review of sepsis-induced cardiomyopathy[J]. J Intensive Care, 2015, 3: 48.
8
Sweeney TE, Khatri P. Septic cardiomyopathy: getting to the heart of the matter[J]. Crit Care Med, 2017, 45(3): 556-557.
9
Sanfilippo F, Orde S, Oliveri F, et al. The challenging diagnosis of septic cardiomyopathy. Chest [J]. 2019, 156(3): 635-636.
10
Martin L, Derwall M, Al Zoubi S, et al. The septic heart: current understanding of molecular mechanisms and clinical implications[J]. Chest, 2019, 155(2): 427-437.
11
Ghadri JR, Wittstein IS, Prasad A, et al. International Expert Consensus Document on Takotsubo Syndrome (Part II): Diagnostic Workup, Outcome, and Management[J]. EurHeart J, 2018, 39(22): 2047-2062.
12
De Backer D, Pinsky M. Norepinephrine improves cardiac function during septic shock, but why?[J]. British Journal of Anaesthesia, 2018, 120(3): 421-424.
13
Hamzaoui O, Jozwiak M, Geffriaud T, et al. Norepinephrine exerts an inotropic effect during the early phase of human septic shock. British journal of anaesthesia [J]. 2018, 120(3): 517-524.
14
Annane D, Ouanes-Besbes L, de Backer D, et al. A global perspective on vasoactive agents in shock[J]. Intensive care medicine, 2018, 44(6): 833-846.
15
Rachoin JS, Dellinger RP. Timing of norepinephrine in septic patients: NOT too little too late[J]. Critical Care, 2014, 18(6):691.
16
Wilkman E, Kaukonen KM, Pettila V, etal. Association between inotrope treatment and 90-day mortality in patients with septic shock[J]. Acta Anaesthesiol Scand, 2013, 57(4): 431-442.
17
Sato R, Nasu M. Time to re-think the use of dobutamine in sepsis[J]. J Intensive Care. 2017, 5: 65.
18
Rhodes A, Evans LE, Alhazzani W, et al. Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock: 2016[J]. Intensive Care Medicine, 2017, 43(3): 304-377.
19
Nishida O, Ogura H, Egi M, et al. The Japanese Clinical Practice Guidelines for Management of Sepsis and Septic Shock 2016 (J-SSCG 2016)[J]. J Intensive Care, 2018, 6: 7.
20
Zausig YA, Geilfus D, Missler G, et al. Direct cardiac effects of dobutamine, dopamine, epinephrine, and levosimendan in isolated septic rat hearts[J]. Shock, 2010, 34(3): 269-274.
21
Annane D, Vignon P, Renault A, et al. Norepinephrine plus dobutamine versus epinephrine alone for management of septic shock: a randomised trial[J]. Lancet, 2007, 370(9588): 676-684.
22
Colling KP, Banton KL, Beilman GJ. Vasopressors in sepsis[J]. Surgical Infections, 2018, 19(2): 202-207.
23
Mahmoud KM, Ammar AS. Norepinephrine supplemented with dobutamine or epinephrine for the cardiovascular support of patients with septic shock[J]. Indian J Crit Care Med, 2012,16(2): 75-80.
24
Levy B. Lactate and shock state: the metabolic view[J]. Curr Opin Crit Care, 2006, 12(4): 315-321.
25
Levy B, Dusang B, Annane D, et al. Cardiovascular response to dopamine and early prediction of outcome in septic shock: a prospective multiple-center study[J]. Crit Care Med, 2005, 33(10): 2172-2177.
26
Treschan TA, Peters J. The vasopressin system: physiology and clinical strategies[J]. Anesthesiology, 2006, 105(3): 599-612; quiz 39-40.
27
Russell JA, Walley KR, Singer J, et al. Vasopressin versus norepinephrine infusion in patients with septic shock[J]. N Engl J Med, 2008, 358(9): 877-887.
28
Mehta S, Granton J, Gordon AC, et al. Cardiac ischemia in patients with septic shock randomized to vasopressin or norepinephrine[J]. Critical Care, 2013, 17(3): R117.
29
29Wasilewski MA, Grisanti LA, Song J, et al. Vasopressin type 1A receptor deletion enhances cardiac contractility, beta-adrenergic receptor sensitivity and acute cardiac injury-induced dysfunction[J]. Clin Sci (Lond), 2016, 130(22): 2017-2027.
30
Radermacher P, Huber-Lang M, Thiemermann C. Catecholamines and the septic heart: opening Pandora′s box?[J]. Shock, 2013, 39(4): 404-405.
31
Tan K, Harazim M, Tang B, et al. The association between premorbid beta blocker exposure and mortality in sepsis-a systematic review[J]. Critical Care, 2019, 23(1): 298.
32
Morelli A, Ertmer C, Westphal M, et al. Effect of heart rate control with esmolol on hemodynamic and clinical outcomes in patients with septic shock: a randomized clinical trial[J]. Jama, 2013, 310(16): 1683-1691.
33
Du W, Wang XT, Long Y, etal. Efficacy and Safety of Esmolol in Treatment of Patients with Septic Shock[J]. Chin Med J (Engl), 2016, 129(14): 1658-1665.
34
Morelli A, Donati A, Ertmer C, et al. Microvascular effects of heart rate control with esmolol in patients with septic shock: a pilot study[J]. Critical Care Medicine, 2013, 41(9): 2162-2168.
35
Ehrman RR, Sullivan AN, Favot MJ, et al. Pathophysiology, echocardiographic evaluation, biomarker findings, and prognostic implications of septic cardiomyopathy: a review of the literature[J]. Critical Care, 2018, 22(1): 112.
[1] 韩媛媛, 热孜亚·萨贝提, 冒智捷, 穆福娜依·艾尔肯, 陆晨, 桑晓红, 阿尔曼·木拉提, 张丽. 组合式血液净化治疗对脓毒症患者血清炎症因子水平和临床预后的影响[J]. 中华危重症医学杂志(电子版), 2023, 16(04): 272-278.
[2] 孟建标, 张庚, 焦燕娜. 脓毒症合并心功能障碍患者早期肠道微生态改变的探讨[J]. 中华危重症医学杂志(电子版), 2023, 16(04): 279-285.
[3] 陈宇, 冯芳, 张露, 刘健. 基于生物信息学分析筛选脓毒症心肌病关键致病基因[J]. 中华危重症医学杂志(电子版), 2023, 16(04): 286-291.
[4] 作者. 脓毒症与脓毒性休克[J]. 中华危重症医学杂志(电子版), 2023, 16(03): 0-.
[5] 莫小乔, 胡喆莹, 廖冬花, 谢天. 脓毒症继发急性肾损伤患者死亡风险预测模型构建及评估[J]. 中华危重症医学杂志(电子版), 2023, 16(03): 198-206.
[6] 张晓燕, 肖东琼, 高沪, 陈琳, 唐发娟, 李熙鸿. 转录因子12过表达对脓毒症相关性脑病大鼠大脑皮质的保护作用及其机制[J]. 中华妇幼临床医学杂志(电子版), 2023, 19(05): 540-549.
[7] 魏徐, 张鸽, 伍金林. 新生儿脓毒症相关性凝血病的监测和治疗[J]. 中华妇幼临床医学杂志(电子版), 2023, 19(04): 379-386.
[8] 姚咏明. 如何精准评估烧伤脓毒症患者免疫状态[J]. 中华损伤与修复杂志(电子版), 2023, 18(06): 552-552.
[9] 窦上文, 邓欢, 刘邦锋, 岳高远志, 朱华财, 刘永达. 术前复查尿培养在预测微通道经皮肾镜取石术相关感染并发症中的作用[J]. 中华腔镜泌尿外科杂志(电子版), 2023, 17(04): 361-366.
[10] 李伟, 卓剑, 黄川, 黄有攀. Lac、HO-1、sRAGE、CRP/ALB表达及脓毒症并发ARDS危险因素分析[J]. 中华肺部疾病杂志(电子版), 2023, 16(04): 514-516.
[11] 苗软昕, 乔晞. Toll样受体在脓毒症性急性肾损伤中的作用[J]. 中华肾病研究电子杂志, 2023, 12(04): 210-214.
[12] 李世明, 黄蔚, 刘玲. HMGB1介导脓毒症相关凝血功能障碍的作用机制及其治疗进展[J]. 中华重症医学电子杂志, 2023, 09(03): 269-273.
[13] 谭睿, 王晶, 於江泉, 郑瑞强. 脓毒症中高密度脂蛋白、载脂蛋白A-I和血清淀粉样蛋白A的作用研究进展[J]. 中华临床医师杂志(电子版), 2023, 17(06): 749-753.
[14] 王震, 杨晓月, 苏康康, 王朝阳, 李少杰, 陈淑霞, 谷剑. β受体阻滞剂对心力衰竭合并房颤患者预后影响的研究进展[J]. 中华临床医师杂志(电子版), 2023, 17(04): 479-482.
[15] 蔡荇, 郑瑞强. 肝素结合蛋白在脓毒症中的应用及研究进展[J]. 中华临床医师杂志(电子版), 2023, 17(04): 487-490.
阅读次数
全文


摘要