Effects of drotrecogin alfa activated on micro circulatory alterations in patients with severe sepsis
Effects of drotrecogin alfa activated on micro circulatory alterations in patients with severe sepsis
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DOI：
10.1097/01.ccm.0000220498.48773.3c
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发表时间：
2006-07-01
影响因子：
8.8
通讯作者：
Vincent, Jean-Louis
中科院分区：
文献类型：
--
作者：
de Backer, Daniel;Verdant, Colin;Vincent, Jean-Louis
目的：微血管改变在脓毒症引起的器官功能障碍的发展中起重要作用。阿法激活的DAA可改善严重脓毒症患者的预后，但其确切的作用机制尚未完全确定。我们研究了DAA是否能影响严重脓毒症患者的微循环改变。设计：前瞻性，非随机研究。一所大学医院的31个床位的内外科重症监护病房。患者：40名符合欧盟DAA管理标准的严重脓毒症成人患者。20例患者接受了药物（DAA），20例患者接受了DAA给药（对照）。正交偏振光谱成像技术被用来显示舌下微循环。在所有患者中，在基线、4小时后以及随后每24小时测量一次，持续7天。在接受DAA的患者中，还在OAA输注结束前和输注结束后4小时进行测量。两组在疾病严重程度、衰竭器官数量和基线微血管改变程度方面匹配良好。在DAA治疗的患者中，灌注毛细血管的比例在4小时时已经增加（从64% [51-80%]增加到84% [71-88%]，p
Objective: Microvascular alterations may play an important role in the development of sepsis-induced organ dysfunction. Drotrecogin alfa activated (DAA) improves outcome in patients with severe sepsis, but its precise mechanism of action is not entirely defined. We investigated whether DAA can influence microcirculatory alterations in patients with severe sepsis.Design: Prospective, nonrandomized study.Setting. A 31-bed, medico-surgical intensive care unit of a university hospital.Patients: Forty adult patients with severe sepsis who met the EU criteria for DAA administration.Interventions. Twenty patients received the drug (DAA) and 20 had a contra indication to DAA administration (control).Measurements and Main Results. An orthogonal polarization spectral imaging technique was used to visualize the sublingual microcirculation. In all patients, measurements were obtained at baseline, 4 hrs later, and then every 24 hrs for up to 7 days. In patients receiving DAA, measurements were also obtained just before and 4 hrs after the end of OAA infusion. The two groups were well matched for severity of disease, number of failing organs, and the degree of microvascular alterations at baseline. The proportion of perfused capillaries increased in the DAA treated patients already at 4 hrs (from 64% [51-80%] to 84% [71-88%], p