【摘要】：目的探討膿毒癥休克患者早期舌下微循環(huán)的改變對(duì)器官功能衰竭的預(yù)測(cè)價(jià)值。方法使用旁流暗視野成像技術(shù)(SDF)觀察診斷為膿毒癥休克24h以內(nèi)的成人患者0h、6h、24h舌下微循環(huán)圖像,根據(jù)24h后器官功能衰竭評(píng)分(SOFA24h-0h評(píng)分)變化分為器官功能惡化組(ΔSOFA24h-0h評(píng)分≥1)和未惡化組(ΔSOFA24h-0h評(píng)分1);分析比較兩組間傳統(tǒng)循環(huán)及舌下微循環(huán)指標(biāo)的變化。結(jié)果兩組患者的年齡、性別、急性生理學(xué)與慢性健康狀況評(píng)分系統(tǒng)Ⅱ(APACHEⅡ評(píng)分)等基本資料差異無統(tǒng)計(jì)學(xué)意義。惡化組和未惡化組相比,0h、6h、24h傳統(tǒng)循環(huán)指標(biāo)〔心率(HR)、平均動(dòng)脈壓(MAP)、中心靜脈壓(CVP)、尿量(urine output,UP)、動(dòng)脈血乳酸(lactate,Lac)〕、血管活性藥物的使用以及輸注晶體液、膠體液的量和液體總量差異均無統(tǒng)計(jì)學(xué)意義。舌下微循環(huán)指標(biāo)小血管灌注比例(PPVs)惡化組在0h〔(75.96±10.55)%vs.(84.03±10.16)%,P=0.032〕和24h時(shí)〔(79.43±9.23)%vs.(86.32±9.02)%,P=0.037〕低于未惡化組,差異有統(tǒng)計(jì)學(xué)意義。繪制0hPPVs和Lac的ROC曲線,曲線下面積PPVs〔0.750(95%CI,0.586~0.914)〕大于Lac〔0.588(95%CI,0.370~0.805)〕,但差異無統(tǒng)計(jì)學(xué)意義(P0.05)。根據(jù)0hPPVs最佳截?cái)嘀?1.5%將患者分為高、低兩組,低PPVs組器官功能惡化發(fā)生率較高PPVs組更高(71.4%vs.20.0%,P0.05)。結(jié)論舌下微循環(huán)指標(biāo)PPVs能夠早于體循環(huán)指標(biāo)反映器官功能的變化,對(duì)器官功能衰竭可能有一定預(yù)測(cè)價(jià)值。
[Abstract]:Objective to investigate the predictive value of early sublingual microcirculation in septic shock patients with organ failure. Methods the sublingual microcirculation images of adult patients with septic shock within 24 hours were observed by side flow dark field imaging (SDF). According to the changes of organ failure score (SOFA24h-0h score) 24 hours later, the patients were divided into two groups: organ function deterioration group (螖 SOFA24h-0h score 鈮，

本文編號(hào)：2399920