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中华重症医学电子杂志 ›› 2021, Vol. 07 ›› Issue (02): 159 -163. doi: 10.3877/cma.j.issn.2096-1537.2021.02.012

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舒张压对脓毒性休克进展预测价值及治疗指导的研究进展
高志伟 1, 谢剑锋 2, 刘玲 2, 陈辉 2, 李聪 2, 杨毅 2 , ( )   
  1. 1. 210000 南京,江苏省重症医学重点实验室 东南大学附属中大医院重症医学科;223300 江苏淮安,南京医科大学附属淮安第一医院急诊医学科
    2. 210000 南京,江苏省重症医学重点实验室 东南大学附属中大医院重症医学科
  • 收稿日期:2021-02-07 出版日期:2021-05-28
  • 通信作者: 杨毅
  • 基金资助:
    国家自然科学基金面上项目(81971888); 江苏省社会发展专项(BE2018743); 江苏省医学重点人才项目(ZDRCA2016082); 江苏省淮安市卫生健康科研立项项目(HAWJ201905)

Clinical research progress of diastolic blood pressure in predicting the progression and guiding the treatment of septic shock

Zhiwei Gao 1, Jianfeng Xie 2, Ling Liu 2, Hui Chen 2, Cong Li 2, Yi Yang 2 , ( )   

  1. 1. Jiangsu Provincial Key Laboratory of Critical Care Medicine, Department of Critical Care Medicine, Zhongda Hospital, School of Medicine Southeast University, Nanjing 210000,China; Department of Emergency, the Affiliated Huaian NO.1 People's Hospital of Nanjing Medical University, Huai'an 223300, China
    2. Jiangsu Provincial Key Laboratory of Critical Care Medicine, Department of Critical Care Medicine, Zhongda Hospital, School of Medicine Southeast University, Nanjing 210000,China
  • Received:2021-02-07 Published:2021-05-28
  • Corresponding author: Yi Yang

部分脓毒性休克患者即使按照拯救脓毒症运动指南进行积极的液体复苏,平均动脉压达标(≥65 mmHg,1 mmHg=0.133 kPa)时仍存在较低的舒张压。而舒张压作为反映血管张力及左心室灌注压力指标,舒张压的降低与病情严重程度及预后密切相关。本文通过查阅相关研究,从脓毒性休克舒张压降低的病理生理机制、舒张压对脓毒性休克发生发展、器官功能障碍和预后的预测价值以及指导早期血管活性药物使用等方面进行综述,以期为重症医师救治脓毒性休克患者提供更多的参考。

Even if patients with septic shock were actively resuscitated in accordance with the guidelines of the surviving sepsis campaign bundle, some patients still had low diastolic blood pressure with a mean arterial pressure ≥65 mmHg. As an indicator of vascular tension and left ventricular perfusion pressure, diastolic blood pressure reduction is closely related to the disease severity and prognosis of septic shock patients. In this manuscript, we reviewed the pathophysiological mechanism of blood pressure reduction in septic shock, the predictive value of diastolic blood pressure on the occurrence and development of septic shock, organ dysfunction and prognosis, as well as the guidance for the early use of vasopressor, providing more information for ICU physicians in management of septic shock.

图1 脓毒症导致的低血压或乳酸≥4 mmol/L的初步复苏流程
1
Shankar-Hari M, Phillips GS, Levy ML, et al. Developing a new definition and assessing new clinical criteria for septic shock: for the Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3) [J]. JAMA, 2016, 315(8): 775-787.
2
Rudd KE, Johnson SC, Agesa KM, et al. Global, regional, and national sepsis incidence and mortality, 1990-2017: analysis for the Global Burden of Disease Study [J]. Lancet, 2020, 395(10219): 200-211.
3
Xie J, Wang H, Kang Y, et al. The epidemiology of sepsis in Chinese ICUs: A national cross-sectional survey [J]. Crit Care Med, 2020, 48(3): e209-e218.
4
Levy MM, Evans LE, Rhodes A. The surviving sepsis campaign bundle: 2018 update [J]. Crit Care Med, 2018, 46(6): 997-1000.
5
Ospina-Tascon GA, Teboul JL, Hernandez G, et al. Diastolic shock index and clinical outcomes in patients with septic shock [J]. Ann Intensive Care, 2020, 10(1): 41.
6
Hamzaoui O, Teboul JL. Importance of diastolic arterial pressure in septic shock: PRO [J]. J Crit Care, 2019, 51: 238-240.
7
Dhainaut JF, Huyghebaert MF, Monsallier JF, et al. Coronary hemodynamics and myocardial metabolism of lactate, free fatty acids, glucose, and ketones in patients with septic shock [J]. Circulation, 1987, 75(3): 533-541.
8
Vidal-Petiot E, Greenlaw N, Ford I, et al. Relationships between components of blood pressure and cardiovascular events in patients with stable coronary artery disease and hypertension [J]. Hypertension, 2018, 71(1): 168-176.
9
Landry DW, Oliver JA. The pathogenesis of vasodilatory shock [J]. N Engl J Med, 2001, 345(8): 588-595.
10
Siegel JH, Greenspan M, Del Guercio LR. Abnormal vascular tone, defective oxygen transport and myocardial failure in human septic shock [J]. Ann Surg, 1967, 165(4): 504-517.
11
Nakae H, Endo S, Inada K, et al. Relationship between thromboxane B2 and 6-keto-prostaglandin F1 alpha in sepsis [J]. Res Commun Chem Pathol Pharmacol, 1994, 83(3): 297-302.
12
Young JD. The heart and circulation in severe sepsis [J]. Br J Anaesth, 2004, 93(1): 114-120.
13
Wanecek M, Weitzberg E, Rudehill A, et al. The endothelin system in septic and endotoxin shock [J]. Eur J Pharmacol, 2000, 407(1-2): 1-15.
14
Lee YI, Smith RL, Gartshteyn Y, et al. Predictors of acute hemodynamic decompensation in early sepsis: An observational study [J]. J Clin Med Res, 2016, 8(8): 575-581.
15
Benchekroune S, Karpati PC, Berton C, et al. Diastolic arterial blood pressure: a reliable early predictor of survival in human septic shock [J]. J Trauma, 2008, 64(5): 1188-1195.
16
Barton C, Chettipally U, Zhou Y, et al. Evaluation of a machine learning algorithm for up to 48-hour advance prediction of sepsis using six vital signs [J]. Comput Biol Med, 2019, 109: 79-84.
17
Faisal M, Richardson D, Scally AJ, et al. Computer-aided national early warning score to predict the risk of sepsis following emergency medical admission to hospital: a model development and external validation study [J]. CMAJ, 2019, 191(14): E382-E389.
18
Holder AL, Gupta N, Lulaj E, et al. Predictors of early progression to severe sepsis or shock among emergency department patients with nonsevere sepsis [J]. Int J Emerg Med, 2016, 9(1): 10.
19
Sato R, Luthe SK, Nasu M. Blood pressure and acute kidney injury [J]. Crit Care, 2017, 21(1): 28.
20
Legrand M, Dupuis C, Simon C, et al. Association between systemic hemodynamics and septic acute kidney injury in critically ill patients: a retrospective observational study [J]. Crit Care, 2013, 17(6): R278.
21
Deep A, Sagar H, Goonasekera C, et al. Evolution of acute kidney injury and its association with systemic hemodynamics in children with fluid-refractory septic shock [J]. Crit Care Med, 2018, 46(7): e677-e683.
22
Cunnion RE, Schaer GL, Parker MM, et al. The coronary circulation in human septic shock [J]. Circulation, 1986, 73(4): 637-644.
23
Ikonomidis I, Makavos G, Nikitas N, et al. Coronary flow reserve is associated with tissue ischemia and is an additive predictor of intensive care unit mortality to traditional risk scores in septic shock [J]. Int J Cardiol, 2014, 172(1): 103-108.
24
Song MJ, Lee SH, Leem AY, et al. Predictors and outcomes of sepsis-induced cardiomyopathy in critically ill patients [J]. Acute Crit Care, 2020, 35(2): 67-76.
25
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]. Crit Care, 2018, 22(1): 112.
26
Lv X, Wang H. Pathophysiology of sepsis-induced myocardial dysfunction [J]. Mil Med Res, 2016, 3: 30.
27
Khan NA, Rabkin SW, Zhao Y, et al. Effect of lowering diastolic pressure in patients with and without cardiovascular disease: analysis of the SPRINT (Systolic Blood Pressure Intervention Trial) [J]. Hypertension, 2018, 71(5): 840-847.
28
Bamoulid J, Philippot H, Kazory A, et al. Acute kidney injury in non-critical care setting: elaboration and validation of an in-hospital death prognosis score [J]. BMC Nephrol, 2019, 20(1): 419.
29
Simon AC, Safar ME, Levenson JA, et al. An evaluation of large arteries compliance in man [J]. Am J Physiol, 1979, 237(5): H550-554.
30
Hernandez G, Ospina-Tascon GA, Damiani LP, et al. Effect of a resuscitation strategy targeting peripheral perfusion status vs serum lactate levels on 28-day mortality among patients with septic shock: the ANDROMEDA-SHOCK randomized clinical trial [J]. JAMA, 2019, 321(7): 654-664.
31
Hamzaoui O, Scheeren TWL, Teboul JL. Norepinephrine in septic shock: when and how much? [J]. Curr Opin Crit Care, 2017, 23(4): 342-347.
32
Permpikul C, Tongyoo S, Viarasilpa T, et al. Early use of norepinephrine in septic shock resuscitation (CENSER). A randomized trial [J]. Am J Respir Crit Care Med, 2019, 199(9): 1097-1105.
33
Li Y, Li H, Zhang D. Timing of norepinephrine initiation in patients with septic shock: a systematic review and meta-analysis [J]. Crit Care, 2020, 24(1): 488.
34
Scheeren TWL, Bakker J, De Backer D, et al. Current use of vasopressors in septic shock [J]. Ann Intensive Care, 2019, 9(1): 20.
35
Cinel I, Kasapoglu US, Gul F, et al. The initial resuscitation of septic shock [J]. J Crit Care, 2020, 57: 108-117.
36
Lakhal K, Ehrmann S, Runge I, et al. Tracking hypotension and dynamic changes in arterial blood pressure with brachial cuff measurements [J]. Anesth Analg, 2009, 109(2): 494-501.
37
Cecconi M, De Backer D, Antonelli M, et al. Consensus on circulatory shock and hemodynamic monitoring. Task force of the European Society of Intensive Care Medicine [J]. Intensive Care Med, 2014, 40(12): 1795-1815.
38
Asfar P, Meziani F, Hamel JF, et al. High versus low blood-pressure target in patients with septic shock [J]. N Engl J Med, 2014, 370(17): 1583-1593.
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