Sakr Yasser, Chierego Marialuisa, Piagnerelli Michaël, Verdant Colin, Dubois Marc-Jacques, Koch Marc, Creteur Jacques, Gullo Antonino, Vincent Jean-Louis, De Backer Daniel
Department of Intensive Care, Erasme University Hospital, Free University of Brussels, Brussels, Belgium.
Crit Care Med. 2007 Jul;35(7):1639-44. doi: 10.1097/01.CCM.0000269936.73788.32.
Microvascular alterations may play a role in the development of multiple organ failure in severe sepsis. The effects of red blood cell transfusions on microvascular perfusion are not well defined. We investigated the effects of red blood cell transfusion on sublingual microvascular perfusion in patients with sepsis.
Prospective, observational study.
A 31-bed, medical-surgical intensive care unit of a university hospital.
Thirty-five patients with severe sepsis requiring red blood cell transfusions.
Transfusion of one to two units of leukocyte-reduced red blood cells.
The sublingual microcirculation was assessed with an Orthogonal Polarization Spectral device before and 1 hr after red blood cell transfusion. Red blood cell transfusions increased hemoglobin concentration from 7.1 (25th-75th percentile, 6.7-7.6) to 8.1 (7.5-8.6) g/dL (p < .01), mean arterial pressure from 75 (69-89) to 82 (75-90) mm Hg (p < .01), and oxygen delivery from 349 (278-392) to 391 (273-473) mL/min.M (p < .001). Microvascular perfusion was not significantly altered by transfusion, but there was considerable interindividual variation. The change in capillary perfusion after transfusion correlated with baseline capillary perfusion (Spearman-rho = -.49; p = .003). Capillary perfusion was significantly lower at baseline in patients who increased their capillary perfusion by >8% compared with those who did not (57 [52-64] vs. 75 [70-79]; p < .01), while hemodynamic and global oxygen transport variables were similar in the two groups. Red blood cell storage time had no influence on the microvascular response to red blood cell transfusion.
The sublingual microcirculation is globally unaltered by red blood cell transfusion in septic patients; however, it can improve in patients with altered capillary perfusion at baseline.
微血管改变可能在严重脓毒症多器官功能衰竭的发生中起作用。红细胞输注对微血管灌注的影响尚不明确。我们研究了红细胞输注对脓毒症患者舌下微血管灌注的影响。
前瞻性观察性研究。
一所大学医院的拥有31张床位的内科-外科重症监护病房。
35例需要输注红细胞的严重脓毒症患者。
输注1至2单位去白细胞红细胞。
在红细胞输注前及输注后1小时，使用正交极化光谱装置评估舌下微循环。红细胞输注使血红蛋白浓度从7.1（第25至75百分位数，6.7 - 7.6）克/分升增至8.1（7.5 - 8.6）克/分升（p < 0.01），平均动脉压从75（69 - 89）毫米汞柱升至82（75 - 90）毫米汞柱（p < 0.01），氧输送量从349（278 - 392）毫升/分钟·米增至391（273 - 473）毫升/分钟·米（p < 0.001）。输血后微血管灌注无显著改变，但个体间存在较大差异。输血后毛细血管灌注的变化与基线毛细血管灌注相关（Spearman秩相关系数 = -0.49；p = 0.003）。与未增加毛细血管灌注的患者相比，毛细血管灌注增加>8%的患者基线时毛细血管灌注显著更低（57 [52 - 64] 对 75 [70 - 79]；p < 0.01），而两组的血流动力学和整体氧运输变量相似。红细胞储存时间对红细胞输注的微血管反应无影响。
脓毒症患者红细胞输注后舌下微循环整体无改变；然而，基线时毛细血管灌注改变的患者其微循环可得到改善。
