Microcirculatory Alterations in Traumatic Hemorrhagic Shock
Microcirculatory Alterations in Traumatic Hemorrhagic Shock
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DOI：
10.1097/ccm.0000000000000223
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发表时间：
2014-06-01
影响因子：
8.8
通讯作者：
Duranteau, Jacques
中科院分区：
文献类型：
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作者：
Tachon, Guillaume;Harrois, Anatole;Duranteau, Jacques
目的：在感染性休克的临床研究中，微循环功能障碍已被广泛报道。然而，还没有临床研究探讨失血性休克的微循环血流行为。本研究的主要目的是评估创伤后4天内创伤性失血性休克患者舌下微循环的时程设计前瞻性观察研究设置ICU患者18例创伤性失血性休克患者干预舌下微循环在手术或血管造影栓塞控制出血后（D1），结果：创伤失血性休克患者经控制出血后，大血管循环恢复正常，舌下微循环障碍持续72 h。此外，我们发现，与D4时的低序贯器官衰竭评估评分患者（序贯器官衰竭评估评分< 6）相比，D4时序贯器官衰竭评估评分高的患者（序贯器官衰竭评估评分6）的微血管流量指数和灌注血管比例的降低显著更高，这两组之间的总体血流动力学无任何差异。结论：创伤性失血性休克患者微循环改变是创伤性失血性休克组织低灌注、创伤性损伤、炎症反应和复苏干预等因素共同作用的结果。尽管大循环恢复，但舌下微循环受损至少72小时。灌注血管的初始比例似乎是D4时高序贯器官衰竭评估评分的良好预测因子。需要进一步的研究来确定创伤性失血性休克患者微血管改变和器官功能障碍之间的联系。
Objectives: Microcirculatory dysfunction has been well reported in clinical studies in septic shock. However, no clinical studies have investigated microcirculatory blood flow behavior in hemorrhagic shock. The main objective of this study was to assess the time course of sublingual microcirculation in traumatic hemorrhagic shock during the first 4 days after trauma.Design Prospective observational study.Setting ICU.Patients Eighteen traumatic hemorrhagic shock patients.Interventions The sublingual microcirculation was estimated at the study inclusion after surgical or angiographic embolization to control bleeding (D1), and then three times at 24-hour intervals (D2, D3, and D4).Measurements and Main Results: Sublingual microcirculation was impaired for 72 hours despite restoration of the macrovascular circulation after control of bleeding in traumatic hemorrhagic shock patients. Furthermore, we found significantly higher decreases in the microvascular flow index and proportion of perfused vessels in high Sequential Organ Failure Assessment score patients at D4 (Sequential Organ Failure Assessment score 6) compared to low Sequential Organ Failure Assessment score patients at D4 (Sequential Organ Failure Assessment score < 6) without any differences in global hemodynamics between these two groups. Finally, the initial proportion of perfused vessels at D1 appears to be a good predictor of high Sequential Organ Failure Assessment score at D4.Conclusions: Alterations of microcirculation in traumatic hemorrhagic shock patients result from the interplay among hemorrhage-induced tissue hypoperfusion, trauma injuries, inflammatory response, and subsequent resuscitation interventions. Despite restoration of the macrocirculation, the sublingual microcirculation was impaired for at least 72 hours. The initial proportion of perfused vessels appears to be a good predictor of high Sequential Organ Failure Assessment score at D4. Further studies are required to firmly establish the link between microvascular alterations and organ dysfunction in traumatic hemorrhagic shock patients.