CAJ | 학술논문

背景综合运用血管活性药物及液体复苏的方法以达到理想的血流动力学指标是当代休克治疗的基本策略.休克患者的血流动力学特征是有效循环容量不足导致微循环灌注障碍和组织器官功能受损.休克的治疗应以改善微循环和组织氧合状态为最终目标.目的近年来随着对各类休克发生机制认识的深入,对各种血管活性药物在休克治疗及调节微循环方面的作用有了进一步的认识,进而对其应用价值做出了重新评价,就此作一综述.内容回顾微循环组成及微循环障碍的表现,总结各种血管活性药物(包括缩血管类药物、扩血管类药物以及部分正性肌力药物)在休克治疗及调节微循环方面的作用的研究进展及临床评价.趋向目前多数研究均未证实血管活性药物对微循环具有确切和积极的改善作用.人们在努力寻找新的理想的药物改善休克组织微循环障碍的同时,积极发展微循环的监测技术,指导液体复苏及血管活性药物的使用,力求以“微循环目标治疗”代替目前基于理想血流动力学指标的复苏目标,以纠正组织氧代谢障碍,保护脏器功能,改善休克患者救治成功率.
배경 종합운용혈관활성약물급액체복소적방법이체도이상적혈류동역학지표시당대휴극치료적기본책략.휴극환자적혈류동역학특정시유효순배용량불족도치미순배관주장애화조직기관공능수손.휴극적치료응이개선미순배화조직양합상태위최종목표.목적 근년래수착대각류휴극발생궤제인식적심입,대각충혈관활성약물재휴극치료급조절미순배방면적작용유료진일보적인식,진이대기응용개치주출료중신평개,취차작일종술.내용 회고미순배조성급미순배장애적표현,총결각충혈관활성약물(포괄축혈관류약물、확혈관류약물이급부분정성기력약물)재휴극치료급조절미순배방면적작용적연구진전급림상평개.추향 목전다수연구균미증실혈관활성약물대미순배구유학절화적겁적개선작용.인문재노력심조신적이상적약물개선휴극조직미순배장애적동시,적겁발전미순배적감측기술,지도액체복소급혈관활성약물적사용,력구이“미순배목표치료”대체목전기우이상혈류동역학지표적복소목표,이규정조직양대사장애,보호장기공능,개선휴극환자구치성공솔.
Background Integrated application of vasoactive agents and fluid resuscitation to attain ideal hemodynamic parameters is the basic strategy of contemporary shock treatment.The hemodynamic features of shock patients are deficiency of effective circulating volume,which leads to microcirculatory disturbance and functional lesion of tissue or organ.Shock treatment should aim at improvement of microcirculation and tissue oxygenation status.Objective Recently,with further acquaintance of pathogenesis underlying various shocks,more recognition on the role vasoactive agents＇ play in shock treatment and microcirculation regulation has been achieved.Therefore,the reassessment has been made about the application value of vasoactive agents,which are reviewed in this article.Content In this article,we review the composition of microcirculation and pathological manifestations of microcirculation disturbance and summarize the research progress and clinic evaluation on the impacts of various vasoactive agents,including vasoconstrictor,vasodilator agents and some positive inotropic agents,on shock treatment and microcirculation regulation.Trend At present,few studies have confirmed the convincible and positive effect of vasoactive agents on microcirculation improvement.Nowadays,novel and ideal drugs aim at improving microcirculation are still under research and development.Microcirculation monitoring technologies are being explored to guide application of vasoactive agents and fluid resuscitation.The present "hemodynamic parameters-target therapy" should be replaced by "microcirculation parameters-target therapy" in shock treatment to rectify tissue oxygen dysmetabolism,protect organ function and improve the successful rate of shock treatment.