De Backer Daniel, Verdant Colin, Chierego Marialuisa, Koch Marc, Gullo Antonino, Vincent Jean-Louis
Department of Intensive Care, Erasme University Hospital, Free University of Brussels, Brussels, Belgium.
Crit Care Med. 2006 Jul;34(7):1918-24. doi: 10.1097/01.CCM.0000220498.48773.3C.
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.
Prospective, nonrandomized study.
A 31-bed, medico-surgical intensive care unit of a university hospital.
Forty adult patients with severe sepsis who met the EU criteria for DAA administration.
Twenty patients received the drug (DAA) and 20 had a contraindication to DAA administration (control).
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 DAA 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 < .01) but not in the control group (from 67% [59-76%] to 68% [61-71%], p = not significant). Microvascular perfusion decreased transiently at the end of DAA infusion. The improvement in microvascular blood flow was associated with a more rapid resolution of hyperlactatemia.
DAA administration rapidly improves sepsis-induced microvascular alterations, whereas its cessation is associated with a transient deterioration.
微血管改变可能在脓毒症诱导的器官功能障碍发展中起重要作用。活化蛋白C（Drotrecogin alfa activated，DAA）可改善严重脓毒症患者的预后，但其确切作用机制尚未完全明确。我们研究了DAA是否能影响严重脓毒症患者的微循环改变。
前瞻性、非随机研究。
一所大学医院的拥有31张床位的内科-外科重症监护病房。
40例符合DAA给药欧盟标准的成年严重脓毒症患者。
20例患者接受药物（DAA）治疗，20例有DAA给药禁忌证（对照组）。
采用正交极化光谱成像技术观察舌下微循环。所有患者在基线、4小时后，然后每24小时测量一次，持续7天。接受DAA治疗的患者在DAA输注结束前和结束后4小时也进行测量。两组在疾病严重程度、衰竭器官数量和基线时微血管改变程度方面匹配良好。在接受DAA治疗的患者中，灌注毛细血管比例在4小时时即已增加（从64%[51 - 80%]增至84%[71 - 88%]，p <.01），而对照组未增加（从67%[59 - 76%]增至68%[61 -71%]，p =无统计学意义）。DAA输注结束时微血管灌注短暂下降。微血管血流的改善与高乳酸血症更快缓解相关。
给予DAA可迅速改善脓毒症诱导的微血管改变，而停止给药则与短暂恶化相关。
