Sublingual microcirculation is impaired in post-cardiac arrest patients.
Sublingual microcirculation is impaired in post-cardiac arrest patients.
复制标题
DOI：
10.1016/j.resuscitation.2013.07.012
复制
发表时间：
2013-12
期刊：
影响因子：
6.5
通讯作者：
Donnino, Michael W.
中科院分区：
文献类型：
--
作者：
Omar, Yasser G.;Massey, Michael;Andersen, Lars W.;Giberson, Tyler A.;Berg, Katherine;Cocchi, Michael N.;Shapiro, Nathan I.;Donnino, Michael W.
我们假设心脏骤停后患者发生与脓毒症相似的微循环功能障碍，并且更好的微循环血流将与改善的结局相关。我们还评估了心脏骤停后微循环功能障碍与炎症标志物之间的关系。我们使用侧流暗场显微镜前瞻性评估了心脏骤停患者、严重脓毒症/脓毒性休克患者和健康对照患者的舌下微循环。采用微循环血流指数（MFI）评估心脏骤停患者在6小时和24小时的微循环血流，以及脓毒症和对照患者在急诊科入院后6小时内的微循环血流。我们评估了30名心脏骤停后患者，16名严重脓毒症/脓毒性休克患者和9名健康对照患者。与对照组（3.0 [IQR：2.9 - 3.0];分别为p < 0.01和0.02）相比，心脏骤停后6小时（MFI 2.6 [IQR：2 - 2.9]）和24小时（2.7 [IQR：2.3 - 2.9]）患者的舌下微循环血流明显受损。在调整初始APACHE II评分后，与脓毒症患者相比，心脏骤停后患者在6小时的MFI显著较低（p < 0.03）。在心脏骤停后组中，神经功能预后良好的患者的微循环血流量优于神经功能预后不良的患者（2.9 [IQR：2.4 - 3.0] vs. 2.6 [IQR：1.9 - 2.8]; p < 0.03）。存活者与非存活者相比，24小时时的中位MFI有较高的趋势（分别为2.8 [IQR：2.4 - 3.0] vs. 2.6 [IQR：2.1-2.8]; p < 0.09）。我们发现MFI-6与血管内皮生长因子（VEGF）呈负相关（r=-0.49，P= 0.038）。然而，在Bonferroni调整多重比较后，这种相关性在统计学上不显著。心脏骤停后患者早期发生微循环功能障碍。24小时微循环功能较好可能与神经功能结局良好相关。
We hypothesized that microcirculatory dysfunction, similar to that seen in sepsis, occurs in post-cardiac arrest patients and that better microcirculatory flow will be associated with improved outcome. We also assessed the association between microcirculatory dysfunction and inflammatory markers in the post-cardiac arrest state. We prospectively evaluated the sublingual microcirculation in post-cardiac arrest patients, severe sepsis/septic shock patients, and healthy control patients using Sidestream Darkfield Microscopy. Microcirculatory flow was assessed using the Microcirculation flow index (MFI) at 6 and 24 hours in the cardiac arrest patients, and within 6 hours of Emergency Department admission in the sepsis and control patients. We evaluated 30 post-cardiac arrest patients, 16 severe sepsis/septic shock patients, and 9 healthy control patients. Sublingual microcirculatory blood flow was significantly impaired in post-cardiac arrest patients at 6 hours (MFI 2.6 [IQR: 2 - 2.9]) and 24 hours (2.7 [IQR: 2.3 - 2.9]) compared to controls (3.0 [IQR: 2.9 - 3.0]; p < 0.01 and 0.02, respectively). After adjustment for initial APACHE II score, post-cardiac arrest patients had significantly lower MFI at 6-hours compared to sepsis patients (p < 0.03). In the post-cardiac arrest group, patients with good neurologic outcome had better microcirculatory blood flow as compared to patients with poor neurologic outcome (2.9 [IQR: 2.4 – 3.0] vs. 2.6 [IQR: 1.9 – 2.8]; p < 0.03). There was a trend toward higher median MFI at 24 hours in survivors vs. non-survivors (2.8 [IQR: 2.4 – 3.0] vs. 2.6 [IQR: 2.1-2.8] respectively; p < 0.09). We found a negative correlation between MFI-6 and vascular endothelial growth factor (VEGF) (r= −0.49, P= 0.038). However, after Bonferroni adjustment for multiple comparisons, this correlation was statistically non-significant. Microcirculatory dysfunction occurs early in post-cardiac arrest patients. Better microcirculatory function at 24 hours may be associated with good neurologic outcome.
登录
查看更多内容
幸存的败血症运动：严重败血症和化粪池冲击管理的国际指南，2012年。
影响因子：
38.9
作者：
Dellinger RP;Levy MM;Rhodes A;Annane D;Gerlach H;Opal SM;Sevransky JE;Sprung CL;Douglas IS;Jaeschke R;Osborn TM;Nunnally ME;Townsend SR;Reinhart K;Kleinpell RM;Angus DC;Deutschman CS;Machado FR;Rubenfeld GD;Webb S;Beale RJ;Vincent JL;Moreno R;Surviving Sepsis Campaign Guidelines Committee including The Pediatric Subgroup
通讯作者：
Surviving Sepsis Campaign Guidelines Committee including The Pediatric Subgroup
影响因子：
120.7
作者：
Nadkarni, VM;Larkin, GL;Berg, RA
通讯作者：
Berg, RA
影响因子：
20.1
作者：
MA, XL;WEYRICH, AS;LEFER, AM
通讯作者：
LEFER, AM
影响因子：
37.8
作者：
Adrie, C;Adib-Conquy, M;Cavaillon, JM
通讯作者：
Cavaillon, JM
DOI：
10.1164/rccm.200109-016oc
发表时间：
2002-07-01
影响因子：
24.7
作者：
De Backer, D;Creteur, J;Vincent, JL
通讯作者：
Vincent, JL