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Báo cáo y học: "Bench-to-bedside review: β-Adrenergic modulation in sepsis"

Tuyển tập các báo cáo nghiên cứu về y học được đăng trên tạp chí y học Critical Care giúp cho các bạn có thêm kiến thức về ngành y học đề tài: Bench-to-bedside review: β-Adrenergic modulation in sepsis. | Available online http ccforum.eom content 13 5 230 Review Bench-to-bedside review p-Adrenergic modulation in sepsis Etienne de Montmollin Jerome Aboab Arnaud Mansart and Djillali Annane Service de Réanimation Polyvalente de l hopital Raymond Poincaré 104 bd Raymond Poincaré 92380 Garches France Corresponding author Professeur Djillali Annane djillali.annane@RPC.aphp.fr Published 23 October 2009 This article is online at http ccforum.com content 13 5 230 2009 BioMed Central Ltd Critical Care 2009 13 230 doi 10.1186 cc8026 Abstract Sepsis despite recent therapeutic progress still carries unacceptably high mortality rates. The adrenergic system a key modulator of organ function and cardiovascular homeostasis could be an interesting new therapeutic target for septic shock. p-Adrenergic regulation of the immune function in sepsis is complex and is time dependent. However P2 activation as well as P1 blockade seems to downregulate proinflammatory response by modulating the cytokine production profile. P1 blockade improves cardiovascular homeostasis in septic animals by lowering myocardial oxygen consumption without altering organ perfusion and perhaps by restoring normal cardiovascular variability. p-Blockers could also be of interest in the systemic catabolic response to sepsis as they oppose epinephrine which is known to promote hyperglycemia lipid and protein catabolism. The role of p-blockers in coagulation is less clear cut. They could have a favorable role in the septic procoagulant state as p1 blockade may reduce platelet aggregation and normalize the depressed fibrinolytic status induced by adrenergic stimulation. Therefore p1 blockade as well as p2 activation improves sepsis-induced immune cardiovascular and coagulation dysfunctions. p2 blocking however seems beneficial in the metabolic field. Enough evidence has been accumulated in the literature to propose p-adrenergic modulation p1 blockade and p2 activation in particular as new promising therapeutic targets .