早期液体复苏对感染性休克病人微循环的影响  

Effects of early goal directed therapy on microcirculation in patients with sepsis shock

作　　者：张泓[1] 李磊[1] 闵东[1] 武钧[1] 瞿洪平[1] 汤耀卿[1] 

机构地区：[1]上海交通大学医学院附属瑞金医院重症医学科,上海200025

出　　处：《外科理论与实践》2015年第2期146-150,共5页Journal of Surgery Concepts & Practice

基　　金：上海高校选拔培养优秀青年教师科研专项基金

摘　　要：目的 :探讨早期液体复苏对感染性休克病人微循环的影响。方法 :回顾性收集2011年10月至2013年12月我科收治并行早期目标导向治疗(EGDT)的21例早期(<12 h)感染性休克病人临床资料,分析实施旁流暗视野成像仪监测舌下微循环和脉搏指示持续心排量监测血流动力学。根据28 d的预后分为生存组11例和死亡组10例,分析两组病人EGDT达标前、后宏观循环及微循环变化。结果:在EGDT治疗后,生存组和死亡组宏观循环参数指标(心率、平均动脉压、中心静脉压、胸腔内血容量指数、每搏指数)均明显改善(P<0.05)。与治疗前相比,生存组微循环血流指数(MFI)和微血管密度指标[灌注血管密度(PVD)、灌注血管比例(PPV)]明显改善(P<0.05),死亡组微循环指标改善不明显(P>0.05);EGDT后,生存组MFI和PVD、PPV显著优于死亡组(P<0.05)。微循环参数(MFI、PVD、PPV)与宏观循环参数(平均动脉压、中心静脉压、胸腔内血容量指数、每搏指数)之间无相关性(P>0.05)。结论:EGDT可显著改善感染性休克病人的宏观循环,但并不能改善所有病人的微循环,微循环灌注是预测感染性休克预后的重要指标。Objective To study the effect of early goal directed therapy （EGDT） on the microcirculation in patients with sepsis shock. Methods A retrospective study was performed in 21 patients with early septic shock within 12 hours detecting sublingual microcirculation using sidestream dark field imaging device and monitoring hemodynamic parameters using pulse indicated continuous cardiac output at our department between October 2011 and December 2013. The patients were given EGDT and divided into survival group （n=11） and death group （n=10）. Both hemodynamic and microcir-culation parameters were collected before and after recovery. Results The macro cycle parameters including mean arterial pressure, central venous pressure, intrathoracic blood volume index and stroke volume index increased and heart rate decreased significantly in the patients both groups after EGDT compared with those pre-EGDT （P〈0.05）. In the survival group, microcirculatory flow index （MFI） of small vessels, perfused vessel density （PVD） and proportion of perfused vessels （PPV） in the patients increased after EGDT （P〈0.05）. However, there were no differences on MFI, PVD and PPV in the patients of death group. After EGDT, MFI, PVD and PPV in the patients of survival group were significantly higher than those in the death group. The microcirculation parameters （MFI, PVD and PPV） were not related linearly to the macro cycle parameters （mean arterial pressure, central venous pressure, intrathoracic blood volume index and stroke volume index） （P〉0.05）. Conclusions EGDT could improve the macro cycle parameters of the patients with sepsis shock, but not the microcirculation of all the patients. The microcirculative peffusion in severe sepsis is the important index for prognosis of the patients.

关 键 词：微循环 感染性休克 早期目标导向治疗 旁流暗视野成像 

分 类 号：R459.7[医药卫生—急诊医学]