Topical nitroglycerin to detect reversible microcirculatory dysfunction in patients with circulatory shock after cardiovascular surgery: an observational study.
Topical nitroglycerin to detect reversible microcirculatory dysfunction in patients with circulatory shock after cardiovascular surgery: an observational study.
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DOI：
10.1038/s41598-022-19741-0
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发表时间：
2022-09-10
影响因子：
4.6
通讯作者：
Abella, Benjamin S.
中科院分区：
文献类型：
--
作者：
Greenwood, John C.;Talebi, Fatima M.;Jang, David H.;Spelde, Audrey E.;Tonna, Joseph E.;Gutsche, Jacob T.;Horak, Jiri;Acker, Michael A.;Kilbaugh, Todd J.;Shofer, Frances S.;Augoustides, John G. T.;Bakker, Jan;Brenner, Jacob S.;Muzykantov, Vladimir R.;Abella, Benjamin S.
微循环功能的持续异常与循环性休克患者的不良临床结局相关。我们试图在心脏手术后循环休克期间使用低剂量局部硝酸甘油溶液和手持视频显微镜来识别急性可逆性微循环功能障碍的患者。40例受试者入组研究，包括20例术前对照和20例术后休克患者。为了测试休克期间微循环功能障碍是否急性可逆，在应用0.1 mL 1%硝酸甘油溶液（1 mg/mL）之前和之后，用入射暗视野显微镜对舌下微循环进行成像。休克组微循环异质性指数高于对照组（MHI 0.33 vs. 0.12，p < 0.001）和较低的微血管血流指数（MFI 2.57 vs. 2.91，p < 0.001），总血管密度（TVD 22.47 vs. 25.90 mm/mm 2，p = 0.005）、灌注血管比例（PPV 90.76 vs. 95.89%，p < 0.001）和灌注血管密度（PVD 20.44 vs. 24.81 mm/mm 2，p < 0.001）。硝酸甘油激发后，休克患者的MFI增加（2.57 vs. 2.97，p < 0.001），TVD（22.47 vs. 27.51 mm/mm2，p < 0.009），PPV（90.76 vs. 95.91%，p < 0.001），PVD（20.44 vs. 26.41 mm/mm 2，p < 0.001）、小静脉RBC速度（402.2 vs. 693.9 µm/s，p < 0.0004）和MHI降低（0.33 vs. 0.04，p < 0.001）。20名患者中有13名显示出药效学反应，定义为PVD从休克基线增加> 1.8 SD。在30分钟的研究期间，血流动力学和血管活性药物剂量没有变化。我们的研究结果表明，局部硝酸甘油挑战手持视频显微镜可以安全地评估局部招聘的微循环血流循环休克患者，可能是一个有用的测试，以确定硝酸甘油的反应。
Persistent abnormalities in microcirculatory function are associated with poor clinical outcomes in patients with circulatory shock. We sought to identify patients with acutely reversible microcirculatory dysfunction using a low-dose topical nitroglycerin solution and handheld videomicroscopy during circulatory shock after cardiac surgery. Forty subjects were enrolled for the study, including 20 preoperative control and 20 post-operative patients with shock. To test whether microcirculatory dysfunction is acutely reversible during shock, the sublingual microcirculation was imaged with incident dark field microscopy before and after the application of 0.1 mL of a 1% nitroglycerin solution (1 mg/mL). Compared to the control group, patients with shock had a higher microcirculation heterogeneity index (MHI 0.33 vs. 0.12, p < 0.001) and a lower microvascular flow index (MFI 2.57 vs. 2.91, p < 0.001), total vessel density (TVD 22.47 vs. 25.90 mm/mm2, p = 0.005), proportion of perfused vessels (PPV 90.76 vs. 95.89%, p < 0.001) and perfused vessel density (PVD 20.44 vs. 24.81 mm/mm2, p < 0.001). After the nitroglycerin challenge, patients with shock had an increase in MFI (2.57 vs. 2.97, p < 0.001), TVD (22.47 vs. 27.51 mm/mm2, p < 0.009), PPV (90.76 vs. 95.91%, p < 0.001), PVD (20.44 vs. 26.41 mm/mm2, p < 0.001), venular RBC velocity (402.2 vs. 693.9 µm/s, p < 0.0004), and a decrease in MHI (0.33 vs. 0.04, p < 0.001. Thirteen of 20 patients showed a pharmacodynamic response, defined as an increase in PVD > 1.8 SD from shock baseline. Hemodynamics and vasoactive doses did not change during the 30-min study period. Our findings suggest a topical nitroglycerin challenge with handheld videomicroscopy can safely assess for localized recruitment of the microcirculatory blood flow in patients with circulatory shock and may be a useful test to identify nitroglycerin responsiveness.
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DOI：
10.1073/pnas.74.8.3203
发表时间：
1977-01-01
影响因子：
11.1
作者：
ARNOLD, WP;MITTAL, CK;MURAD, F
通讯作者：
MURAD, F
影响因子：
5.7
作者：
Klijn, Eva;Den Uil, C. A.;Ince, Can
通讯作者：
Ince, Can
影响因子：
38.9
作者：
Ince, Can;Boerma, E. Christiaan;Scheeren, Thomas W. L.
通讯作者：
Scheeren, Thomas W. L.
DOI：
10.2147/dddt.s79116
发表时间：
2015
期刊：
Drug design, development and therapy
影响因子：
--
作者：
Boden WE;Padala SK;Cabral KP;Buschmann IR;Sidhu MS
通讯作者：
Sidhu MS
DOI：
10.1016/s0022-5223(00)70138-3
发表时间：
2000-03-01
影响因子：
6
作者：
Massoudy, P;Zahler, S;Meisner, H
通讯作者：
Meisner, H