脓毒性休克患者舌色与舌下微循环及预后关系  

Association between tongue color,sublingual microcirculation and prognoses in patients with septic shock

作　　者：高伟[1,2] 曹鹏 倪海滨[1,2] 张家留[1,2] 周丹丹[1,2] 殷丽萍[1,2] 张丰 朱启勇[1,2] Gao Wei;Cao Peng;Ni Haibin;Zhang Jialiu;Zhou Dandan;Yin Liping;Zhang Feng;Zhu Qiyong(Department of Critical Care Medicine,Affiliated Hospital of Integrated Traditional Chinese and Western Medicine,Nanjing University of Chinese Medicine,Jiangsu 210023,China;Jiangsu Provincial Academy of Traditional Chinese Medicine,Jiangsu 210028,China)

机构地区：[1]南京中医药大学附属中西医结合医院重症医学科,南京210023 [2]江苏省中医药研究院

出　　处：《北京中医药大学学报》2019年第2期171-176,共6页Journal of Beijing University of Traditional Chinese Medicine

基　　金：国家自然科学基金项目(No.81673932);江苏省自然科学基金社发项目(No.BE2017768);江苏省中医药局科技项目(No.YB2015040);中国中医科学院江苏分院青年课题项目(No.JSBY1307)~~

摘　　要：目的探讨不同舌色脓毒性休克患者舌下微循环差异以及与患者预后之间的关系。方法采用前瞻性研究方法,选择2017年5月—2018年5月南京中医药大学附属中西医结合医院重症医学科收治的资料完整的脓毒性休克患者,根据患者早期复苏6 h后舌色将患者分为红舌组及紫舌组,应用旁流暗视野技术(SDF)测定患者舌下微循环的总血管密度(TVD)、灌注血管密度(PVD)、灌注血管比例(PPV)、微血管流动指数(MFI),记录患者28 d生存情况,比较两组患者早期复苏6 h后舌下微循环及预后差异。结果共入选59例脓毒性休克患者,红舌组34例,紫舌组25例。与红舌组比较,紫舌组患者急性生理与慢性健康Ⅱ评分(APACHEⅡ)、序贯器官衰竭评分(SOFA)及动脉乳酸(Lac)明显升高,28 d死亡率更高。舌下微循环指标TVD、PVD、PPV和MFI明显降低。多因素Logistic回归分析显示紫舌和乳酸水平是患者28 d死亡的独立危险因素。Kaplan-Meier生存分析显示紫舌组患者的累计28 d生存率明显低于红舌组(P<0.001)。结论舌色与脓毒性休克患者舌下微循环及预后相关,可作为评估脓毒性休克患者28 d生存率的独立预后指标。Objective To study the sublingual microcirculation in patients suffering from septic shock with different tongue colors,and explore the relationship between tongue colors and prognoses.Methods A prospective observational study was carried out.Patients with septic shock admitted in Intensive Care Unit(ICU) in Hospital of Integrated Traditional Chinese and Western Medicine affiliated to Nanjing University of Chinese Medicine from May 2017 to May 2018 with completed medical records were selected.The patients were divided into two groups(red-tongue group and purple-tongue group) based on tongue colors at 6 h after initial resuscitation.Total vessel density(TVD),perfused vessel density(PVD),proportion of perfused vessel(PPV),and microvascular flow index(MFI) were detected with sublingual sidestream dark-field(SDF) technology.Sublingual microcirculatory and prognoses in two group groups were compared according to above parameters.Results There were 59 patients in two groups,red tongue color group(RTC,n =34),and purple tongue color group(PTC,n =25).Compared with RTC group,APACHE II score,SOFA score and arterial lactate in PTC group were significantly higher;PTC group had a significantly higher 28-day mortality rate.Compared with RTC group,TVD,PVD,PPV,and MFI were significantly lower in PTC group.Purple tongue color and arterial lactate level had close relationship with mortality according to multivariate logistic analysis.Kaplan-Meier survival analysis demonstrated survival rate of 28-day in the PTC was significantly lower than that in RTC(P<0.001).Conclusion Tongue color may correlate with sublingual microcirculation and prognoses.It can be used to estimate survival rate in 28 days of patients with septic shock.

关 键 词：脓毒性休克 舌色 舌下微循环 旁流暗视野技术 预后 

分 类 号：R241.25[医药卫生—中医诊断学]