不同海拔脓毒性休克患者的早期舌下微循环变化  

Early sublingual microcirculation changes in patients with septic shock at different altitudes

作　　者：何宗钊[1] 王皓[2] 郭利涛[3] 马四清[2] 项辉[4] 郑兴[2] HE Zongzhao;WANG Hao;GUO Litao;MA Siqing;XIANG Hui;ZHENG Xing(Department of Anesthesiology,Qinghai Provincial People's Hospital,Xining,Qinghai 810000,China)

机构地区：[1]青海省人民医院麻醉科,青海西宁810000 [2]青海省人民医院重症医学科,青海西宁810000 [3]西安交通大学附属第一医院,陕西西安710061 [4]武汉大学中南医院,湖北武汉430071

出　　处：《中国临床研究》2024年第11期1695-1699,共5页Chinese Journal of Clinical Research

基　　金：青海省卫生健康委一般指导性课题(2020-wjzdx-03);2023年度青海省“昆仑英才·高层次卫生健康人才”项目。

摘　　要：目的观察不同海拔地区脓毒性休克患者早期舌下微循环的变化情况,为临床治疗高海拔地区脓毒性休克患者提供参考。方法选取2021年9月至2023年3月在青海省人民医院和武汉大学中南医院重症医学科,收治的高海拔地区(西宁)28例和低海拔地区(武汉)26例脓毒性休克患者作为研究对象,记录患者基础资料、血细胞计数、炎症指标、凝血功能指标[凝血酶原时间(PT)、凝血酶时间(TT)、国际标准化比值(INR)],应用旁流暗视野成像(SDF)监测技术监测舌下微循环指标[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)、异质性指数(HI)]。比较不同海拔地区患者舌下微循环的变化。结果两地区脓毒性休克患者基础资料、炎症指标及INR比较差异无统计学意义(P>0.05);高海拔地区脓毒性休克患者PT[19.65(16.80,31.50)s vs 14.60(12.92,18.65)s]、TT[20.45(18.78,23.18)s vs 15.65(13.82,19.55)s]较低海拔患者延长(P<0.05)。与低海拔患者相比,高海拔脓毒性休克患者TVD[17.37(13.61,19.65)mm/mm^(2) vs 14.18(13.10,16.07)mm/mm^(2)]、HI[1.60(0.55,3.00)vs 0.71(0.44,1.05)]显著增加(P<0.05);而PVD[3.29(1.83,11.24)mm/mm^(2) vs 12.66(9.39,14.87)mm/mm^(2)]、PPV[22.55%(10.28%,77.15%)vs 87.85%(72.02%,94.65%)]、MFI[0.87(0.63,1.95)vs 2.50(2.24,2.71)]显著降低(P<0.05)。结论高海拔地区脓毒性休克患者舌下微循环障碍较低海拔患者更为明显,其中PVD、PPV、MFI明显减少,HI更为突出。Objective To observe the changes of early sublingual microcirculation in patients with septic shock at different altitudes,and to provide reference for clinical treatment of patients with septic shock at high altitude.Methods From September 2021 to March 2023,patients with septic shock at high altitude(Xining,28 cases)and at low altitude(Wuhan,26 cases)were selected as study subjects in the Department of Intensive Care Medicine of Qinghai Provincial People's Hospital and Zhongnan Hospital of Wuhan University.The basal data,blood cell counts,inflammation indexes,and coagulation function indexes[prothrombin time(PT),thrombin time(TT),and international normalized ratio(INR)]were recoded.The sidestream dark field(SDF)monitoring technique was used to monitor sublingual microcirculation indexes[total vascular density(TVD),perfusion vascular density(PVD),proportion of perfused vessels(PPV),microfluidic flow index(MFI),and heterogeneity index(HI)].The changes of sublingual microcirculation in patients at different altitudes were compared.Results There was no statistically significant difference in the comparison of basic information,inflammation indexes and INR between patients with septic shock in the two regions(P>0.05).However,the PT[19.65(16.80,31.50)s vs 14.60(12.92,18.65)s]and TT[20.45(18.78,23.18)s vs 15.65(13.82,19.55)s]were significantly longer in the high-altitude region compared to the low-altitude region(P<0.05).Compared with patients in low altitude,TVD[17.37(13.61,19.65)mm/mm^(2) vs 14.18(13.10,16.07)mm/mm^(2)]and HI[1.60(0.55,3.00)vs 0.71(0.44,1.05)]were significantly higher,while PVD[3.29(1.83,11.24)mm/mm^(2) vs 12.66(9.39,14.87)mm/mm^(2)]、PPV[22.55%(10.28%,77.15%)vs 87.85%(72.02%,94.65%)],and MFI[0.87(0.63,1.95)vs 2.50(2.24,2.71)]were significantly lower in high altitude region(P<0.05).Conclusion The disturbance of sublingual microcirculation in patients with septic shock at high altitude is more pronounced compared to those at low altitude.Specifically,there is a significant reduction in PVD,PPV,and M

关 键 词：脓毒症 脓毒性休克 海拔 舌下微循环 血管密度 凝血功能 

分 类 号：R631.4[医药卫生—外科学]