Confocal laser endomicroscopy reliably detects sepsis-related and treatment-associated changes in intestinal mucosal microcirculation.
Confocal laser endomicroscopy reliably detects sepsis-related and treatment-associated changes in intestinal mucosal microcirculation.
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DOI：
10.1093/bja/aet219
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发表时间：
2013-12
影响因子：
9.8
通讯作者：
C. Schmidt;C. Lautenschläger;B. Petzold;Y. Sakr;G. Marx;A. Stallmach
中科院分区：
文献类型：
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作者：
C. Schmidt;C. Lautenschläger;B. Petzold;Y. Sakr;G. Marx;A. Stallmach
背景微循环改变在脓毒症的病理生理学中起核心作用。我们研究了基于探针的共聚焦激光显微内镜（pCLE），以评估在感染性休克猪模型和符合严重脓毒症共识标准的患者体内粘膜微循环灌注的变化。方法在麻醉、机械通气的猪中使用粪性腹膜炎模型诱导感染性休克。在胃、十二指肠、末端回肠和直肠中使用pCLE评估粘液微循环。在10例严重脓毒症患者和8例健康对照者中进一步评价了十二指肠微循环，以量化毛细血管直径、毛细血管长度和功能性毛细血管密度（FCD）。结果脓毒症动物模型中，脓毒症后4 h，十二指肠（P <0.001）、回肠（P<0.001）、胃（P<0.001）和直肠（P<0.005）黏膜FCD均显著降低;容量治疗后，FCD部分恢复至基线值的90.0%（十二指肠）、94.4%（回肠）、95.4%（胃）和97%（直肠），表明微血管和大血管血流解耦。脓毒症组十二指肠粘膜毛细血管平均直径（P<0.01）和FCD（P<0.05）较正常对照组明显减小。结论：pCLE可靠地检测和量化了猪脓毒症模型和严重脓毒症患者胃肠道粘膜的微循环改变。我们的数据表明，pCLE是一个很有前途的工具，以评估疗效的治疗干预粘膜微循环的实时，甚至在临床上。
BACKGROUND Microcirculatory alterations play a central role in the pathophysiology of sepsis. We investigated probe-based confocal laser endomicroscopy (pCLE) to assess alterations in mucosal microcirculatory perfusion in vivo in a porcine model of septic shock and in patients fulfilling consensus criteria for severe sepsis. METHODS Septic shock was induced using a faecal peritonitis model in anaesthetized, mechanically ventilated pigs. Mucosal microcirculation was assessed using pCLE in the stomach, duodenum, terminal ileum, and rectum. Duodenal microcirculation was further evaluated in 10 patients with severe sepsis and in 8 healthy controls to quantify capillary diameter, capillary length, and functional capillary density (FCD). RESULTS In the animal model, FCD was markedly decreased in duodenal (P<0.001), ileal (P<0.001), gastric (P<0.001), and rectal mucosa (P<0.005) 4 h after induction of sepsis. After volume therapy, FCD partially recovered to 90.0% (duodenum), 94.4% (ileum), 95.4% (gastric), and 97% (rectum) of baseline values, indicating decoupling of microvascular and macrovascular flow. In septic patients, the mean capillary diameter (P<0.01) and FCD (P<0.05) in duodenal mucosa were decreased compared with healthy controls. CONCLUSIONS pCLE reliably detected and quantified microcirculatory alterations in the gastrointestinal mucosa in a porcine model of sepsis and in patients with severe sepsis. Our data suggest that pCLE is a promising tool to assess the efficacy of therapeutic interventions on mucosal microcirculation in real-time, even in the clinical context.