Marked regional endothelial dysfunction in mottled skin area in patients with severe infections
Marked regional endothelial dysfunction in mottled skin area in patients with severe infections
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DOI：
10.1186/s13054-017-1742-x
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发表时间：
2017-06-23
期刊：
影响因子：
15.1
通讯作者：
Ait-Oufella, Hafid
中科院分区：
文献类型：
--
作者：
Bourcier, Simon;Joffre, Jeremie;Ait-Oufella, Hafid
背景：膝关节周围的斑点反映了皮肤血流量的减少，是感染性休克患者死亡率的预测指标。然而，斑驳的病因病理生理学仍然未知。我们假设，在斑驳的区域观察到的皮肤低灌注与区域内皮功能障碍。方法：这是一个前瞻性的，观察性研究，在医学ICU在三级教学医院。入选ICU连续性脓毒症成人患者。复苏后，在前臂和膝盖区域的乙酰胆碱（Ach）离子电渗之前和之后，测量皮肤循环中的内皮依赖性血管舒张。我们分析了诱导血管舒张的模式，根据存在或不存在的斑驳和生命状态在14 day.Results：我们评估了37例脓毒症患者，包括11例没有和26例感染性休克。总体14天死亡率为22%。10例患者（10/37，27%）膝关节周围有斑点。在膝关节区域，与无斑驳皮肤的患者相比，有斑驳皮肤的患者在Ach离子电渗后增加的皮肤血流量较低（曲线下面积（AUC）3280（2643-6440）vs. 7980（4233- 19，707），均P < 0.05）。在前臂区域，Ach离子导入后增加的皮肤血流量在有和没有斑驳皮肤的患者中是相似的。在感染性休克患者中，14天时，与存活者相比，非存活者膝关节区域Ach离子电渗后皮肤血流量增加显著较低（AUC 3256（2600-4426）vs. 7704（4539- 15，011），P < 0.01）。在感染性休克患者中，增加皮肤血流量在前臂地区的乙酰胆碱离子导入后是相似的幸存者和非幸存者在14 day.Conclusion：斑驳与区域内皮功能障碍的感染性休克患者。非幸存者膝关节皮肤区域的内皮功能障碍比幸存者更明显。
Background: Mottling around the knee, reflecting a reduced skin blood flow, is predictive of mortality in patients with septic shock. However, the causative pathophysiology of mottling remains unknown. We hypothesized that the cutaneous hypoperfusion observed in the mottled area is related to regional endothelial dysfunction.Methods: This was a prospective, observational study in a medical ICU in a tertiary teaching hospital. Consecutive adult patients with sepsis admitted to ICU were included. After resuscitation, endothelium-dependent vasodilation in the skin circulation was measured before and after iontophoresis of acetylcholine (Ach) in the forearm and the knee area. We analyzed the patterns of induced vasodilatation according to the presence or absence of mottling and vital status at 14 days.Results: We evaluated 37 septic patients, including 11 without and 26 with septic shock. Overall 14-day mortality was 22%. Ten patients had mottling around the knee (10/37, 27%). In the knee area, the increased skin blood flow following iontophoresis of Ach was lower in patients with mottled skin as compared to patients without mottled skin (area under curve (AUC) 3280 (2643-6440) vs. 7980 (4233-19,707), both P < 0.05). In the forearm area, the increased skin blood flow following iontophoresis of Ach was similar in patients with and without mottled skin. Among patients with septic shock, the increased skin blood flow following iontophoresis of Ach in the knee area was significantly lower in non-survivors as compared to survivors at 14 days (AUC 3256 (2600-4426) vs. 7704 (4539-15,011), P < 0.01). In patients with septic shock, the increased skin blood flow in the forearm area following iontophoresis of Ach was similar in survivors and non-survivors at 14 days.Conclusion: Mottling is associated with regional endothelial dysfunction in patients with septic shock. Endothelial dysfunction in the knee skin area was more pronounced in non-survivors than in survivors.