Microvascular blood flow is altered in patients with sepsis
Microvascular blood flow is altered in patients with sepsis
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DOI：
10.1164/rccm.200109-016oc
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发表时间：
2002-07-01
影响因子：
24.7
通讯作者：
Vincent, JL
中科院分区：
文献类型：
--
作者：
De Backer, D;Creteur, J;Vincent, JL
脓毒症动物模型中微血管血流改变很常见，可能会损害组织氧合。我们假设脓毒症患者存在微循环的改变。我们使用正交偏振光谱成像技术调查了 10 名健康志愿者、16 名心脏手术前患者、10 名非脓毒症急性患者（重症监护病房对照受试者）和 50 名严重脓毒症患者的舌下微循环。在 11 名脓毒症患者中测试了局部应用乙酰胆碱 (10(-2) M) 的效果。对每个受试者的五到七个舌下区域进行半定量记录和分析。数据通过非参数检验进行分析，并以中位数（第 25-75 个百分位数）表示。在健康志愿者和心脏手术前的患者或重症监护病房对照受试者之间，没有观察到微血管血流量的显着差异。严重脓毒症患者的所有血管密度均显着降低（志愿者中为 4.5 [4.2-5.2] 对比 5.4 [5.4-6.3]/mm，p < 0.01）。脓毒症患者的小血管（< 20 μm）灌注比例减少（志愿者中为 48 [33-61]%，而志愿者为 90 [89-92]%，p < 0.001）。这些改变在非幸存者中更为严重。局部应用乙酰胆碱完全逆转了这些改变。总之，脓毒症患者的微血管血流改变很频繁，并且预后较差的患者更严重。
Microvascular blood flow alterations are frequent in animal models of sepsis and may impair tissue oxygenation. We hypothesized that alterations of the microcirculation are present in patients with sepsis. We used an orthogonal polarization spectral imaging technique to investigate the sublingual microcirculation in 10 healthy volunteers, 16 patients before cardiac surgery, 10 acutely ill patients without sepsis (intensive care unit control subjects), and 50 patients with severe sepsis. The effects of topical application of acetylcholine (10(-2) M) were tested in 11 patients with sepsis. In each subject, five to seven sublingual areas were recorded and analyzed semiquantitatively. Data were analyzed with nonparametric tests and are presented as medians (25th-75th percentiles). No significant difference in microvascular blood flow was observed between healthy volunteers and patients before cardiac surgery or intensive care unit control subjects. The density of all vessels was significantly reduced in patients with severe sepsis (4.5 [4.2-5.2] versus 5.4 [5.4-6.3]/mm in volunteers, p < 0.01). The proportion of perfused small (< 20 mum) vessels was reduced in patients with sepsis (48 [33-61] versus 90 [89-92]% in volunteers, p < 0.001). These alterations were more severe in nonsurvivors. The topical application of acetylcholine totally reversed these alterations. In conclusion, microvascular blood flow alterations are frequent in patients with sepsis and are more severe in patients with a worse outcome.