A high mean arterial pressure target is associated with improved microcirculation in septic shock patients with previous hypertension: a prospective open label study.
A high mean arterial pressure target is associated with improved microcirculation in septic shock patients with previous hypertension: a prospective open label study.
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高平均动脉压目标与既往患有高血压的感染性休克患者的微循环改善相关：一项前瞻性开放标签研究
DOI：
10.1186/s13054-015-0866-0
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发表时间：
2015-03-30
期刊：
影响因子：
--
通讯作者：
Qiu HB
中科院分区：
文献类型：
--
作者：
Xu JY;Ma SQ;Pan C;He HL;Cai SX;Hu SL;Liu AR;Liu L;Huang YZ;Guo FM;Yang Y;Qiu HB
平均动脉压升高对感染性休克合并高血压患者微循环的影响尚不清楚。我们的目标是评估平均动脉压滴定到一个更高的水平对高血压感染性休克patients.MethodsThis微循环的影响是一个单中心，开放标签的研究。入选了在充分液体复苏后感染性休克持续时间少于24小时且需要去甲肾上腺素维持平均动脉压65 mmHg的高血压患者。然后用去甲肾上腺素将平均动脉压从65 mmHg滴定至患者的正常水平。除了血流动力学变量，舌下微循环评价侧流暗场imaging. Results 19例患者参加了这项研究。平均动脉压从65 mmHg升高至正常水平与中心静脉压（从11 ± 4至13 ± 4 mmHg，P= 0.002）、心输出量（从5.4 ± 1.4至6.4 ± 2.1 l/min，P= 0.001）和中心静脉血氧饱和度（从81 ± 7至83 ± 7%，P = 0.001）升高相关。小灌注血管密度显著增加（从10.96 ± 2.98到11.99 ± 2.55支血管/mm 2，P= 0.009），小灌注血管比例（从85 ± 18%到92 ± 14%，P = 0.002），小微血管血流指数（从2.45 ± 0.61到2.80 ± 0.68，P= 0.009）结论平均动脉压从65 mmHg升高到正常水平与高血压感染性休克微循环改善有关试验registrationClinicaltrials.gov： NCT01443494 ; 2011年9月28日登记。
IntroductionThe effect of mean arterial pressure titration to a higher level on microcirculation in septic shock patients with previous hypertension remains unknown. Our goal is to assess the effect of mean arterial pressure titration to a higher level on microcirculation in hypertensive septic shock patients.MethodsThis is a single-center, open-label study. Hypertensive patients with septic shock for less than 24 hours after adequate fluid resuscitation and requiring norepinephrine to maintain a mean arterial pressure of 65 mmHg were enrolled. Mean arterial pressure was then titrated by norepinephrine from 65 mmHg to the normal level of the patient. In addition to hemodynamic variables, sublingual microcirculation was evaluated by sidestream dark field imaging.ResultsNineteen patients were enrolled in the study. Increasing mean arterial pressure from 65 mmHg to normal levels was associated with increased central venous pressure (from 11 ± 4 to 13 ± 4 mmHg,P= 0.002), cardiac output (from 5.4 ± 1.4 to 6.4 ± 2.1 l/minute,P= 0.001), and central venous oxygen saturation (from 81 ± 7 to 83 ± 7%,P= 0.001). There were significant increases in small perfused vessel density (from 10.96 ± 2.98 to 11.99 ± 2.55 vessels/mm2,P= 0.009), proportion of small perfused vessels (from 85 ± 18 to 92 ± 14%,P= 0.002), and small microvascular flow index (from 2.45 ± 0.61 to 2.80 ± 0.68,P= 0.009) when compared with a mean arterial pressure of 65 mmHg.ConclusionsIncreasing mean arterial pressure from 65 mmHg to normal levels is associated with improved microcirculation in hypertensive septic shock patients.Trial registrationClinicaltrials.gov: NCT01443494 ; registered 28 September 2011.
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