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The microcirculation as a functional system

机译:微循环作为功能系统

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This review examines experimental evidence that the microvascular dysfunction that occurs early in sepsis is the critical first stage in tissue hypoxia and organ failure. A functional microvasculature maintains tissue oxygenation despite limitations on oxygen delivery from blood to tissue imposed by diffusion; the density of perfused (functional) capillaries is high enough to ensure appropriate diffusion distances, and arterioles regulate the distribution of oxygen within the organ precisely to where it is needed. Key components of this regulatory system are the endothelium, which communicates and integrates signals along the microvascular network, and the erythrocytes, which directly monitor and regulate oxygen delivery. During hypovolemic shock, a functional microvasculature responds to diminish the impact of a decrease in oxygen supply on tissue perfusion. However, within hours of the onset of sepsis, a dysfunctional microcirculation is, due to a loss of functional capillary density and impaired regulation of oxygen delivery, unable to maintain capillary oxygen saturation levels and prevent the rapid onset of tissue hypoxia despite adequate oxygen supply to the organ. The mechanism(s) responsible for this dysfunctional microvasculature must be understood in order to develop appropriate management strategies for sepsis.
机译:这篇综述检查了实验证据,即败血症早期发生的微​​血管功能障碍是组织缺氧和器官衰竭的关键第一阶段。尽管通过扩散施加的从血液到组织的氧气输送受到限制,但功能性微血管仍能维持组织的充氧。灌注的(功能性)毛细管的密度足够高,可以确保适当的扩散距离,并且小动脉可将氧气精确地调节到需要的器官中。该调节系统的关键组件是沿微血管网络传递和整合信号的内皮,以及直接监测和调节氧气输送的红细胞。在低血容量性休克期间,功能性微脉管系统会响应以减少氧气供应减少对组织灌注的影响。然而,在败血症发作的几小时内,由于功能性毛细血管密度的丧失和氧气输送的调节受损,导致微循环功能障碍,尽管有足够的氧气供应,但仍不能维持毛细血管的氧饱和度并阻止组织缺氧的快速发作。器官。必须了解造成这种功能失调的微脉管系统的机制,以便制定适当的脓毒症管理策略。

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