Jung Christian, Rödiger Christoph, Lauten Alexander, Fritzenwanger Michael, Goebel Bjoern, Schumm Julia, Figulla Hans-Reiner, Ferrari Markus
Klinik für Innere Medizin I (Kardiologie, Angiologie, Pneumologie und Intensivmedizin), Universitätsklinik der Friedrich-Schiller-Universität Jena, Erlanger Allee 101, 07747, Jena, Germany.
Med Klin (Munich). 2009 May 15;104(5):336-42. doi: 10.1007/s00063-009-1071-1. Epub 2009 May 16.
Microcirculation has become a major focus of research in critical care medicine due to its growing clinical relevance detecting changes in organ perfusion at an early stage. A negative impact of propofol infusion on microcirculation during short-term anesthesia was described recently. The influence of long-term sedation with propofol on microflow of critical care patients is still unclear.
Microflow was analyzed using sidestream darkfield microscopy of sublingual mucosa in 28 patients of whom eleven received continuous infusion of propofol. According to current guidelines, microflow was recorded digitally. Quantitative analysis was performed offline in a semiquantitative way (0: no flow; 1: intermittent flow; 2: sluggish flow; 3: continuous flow).
Good microflow rates were detected in sublingual vessels (10-100 microm) in hemodynamically stable, medical intensive care patients. In the majority of cases, continuous flow profiles were recorded. There was no difference in flow rates between patients with and without propofol therapy.
In hemodynamically stable intensive care patients, long-term therapy with propofol did not affect sublingual microflow in this small cohort. However, intensive care physicians should keep such possible interactions in mind avoiding administration of these substances in patients with manifested shock. The effects of propofol in hemodynamically impaired patients should be evaluated in further studies.
由于微循环在早期检测器官灌注变化方面的临床相关性日益增加，它已成为重症监护医学研究的主要焦点。最近有研究描述了丙泊酚输注在短期麻醉期间对微循环的负面影响。丙泊酚长期镇静对重症监护患者微血流的影响仍不清楚。
对28例患者的舌下黏膜采用侧流暗视野显微镜分析微血流，其中11例接受丙泊酚持续输注。根据现行指南，以数字方式记录微血流。离线进行半定量的定量分析（0：无血流；1：间歇性血流；2：血流缓慢；3：连续血流）。
在血流动力学稳定的内科重症监护患者的舌下血管（10 - 100微米）中检测到良好的微血流率。在大多数情况下，记录到连续的血流模式。接受丙泊酚治疗和未接受丙泊酚治疗的患者之间血流率没有差异。
在这个小队列中，血流动力学稳定的重症监护患者长期使用丙泊酚治疗并未影响舌下微血流。然而，重症监护医生应牢记这种可能的相互作用，避免在已出现休克的患者中使用这些药物。丙泊酚在血流动力学受损患者中的作用应在进一步研究中进行评估。
