Wiessner R, Gierer P, Schaser K, Pertschy A, Vollmar B, Klar E
Universität Rostock, Medizinische Fakultät, Abteilung für Allgemein-, Gefäss-, Thorax- und Transplantationschirurgie, Rostock.
Zentralbl Chir. 2009 Jun;134(3):231-6. doi: 10.1055/s-0028-1098702. Epub 2009 Jun 17.
Haemodynamic monitoring of septic patients is impeded by the discrepancy between the macrohaemodynamics and the microcirculation of internal organs. Pulse contour analysis (PiCCO) provides new parameters for an improved assessment of the volume status of critically ill patients. However, changes in regional circulation, in particular those affecting the splanchnic perfusion, have proven to be especially important. The aim of our study was to compare macrohaemodynamic parameters (PiCCO) with microcirculation (OPS imaging) in severely septic patients with multiple organ failure.
In seven patients suffering from septic shock and multiple organ failure (APACHE II score > 25) repeated examinations at a twenty-four hour interval were carried out by PiCCO monitoring and OPS imaging. OPS data were recorded for twenty seconds at 6 different buccal and sublingual localisations, adequately reflecting microvascular perfusion of the liver and the small intestine. Data were videotaped for off-line analysis, calculating current velocity in small and large venules (< 25 and > 25 microm), as well as functional capillary density.
Significant correlations were found for current velocity in small venules with systemic vascular resistance (r(2) = 0.252, p < 0.05), mean arterial blood pressure (r(2) = 0.259, p < 0.05), and pH value (r(2) = 0.265, p < 0.05). In addition, a significant correlation was found between the oxygen transport index and the density of small vessels (r(2) = 0.355; p < 0.05).
According to our findings, data acquired through PiCCO monitoring may be used for a rough estimation of the microcirculation during severe sepsis and multiple organ failure. For an assessment of the local conditions of perfusion, however, there are limits in the use of the parameters that were the object of our research. For the measurement at localisations which are accessible non-invasively and representative of the splanchnic perfusion, OPS is the more accurate method for characterisation of the microcirculation, although a more extensive and time-consuming analysis is needed.
脓毒症患者的血流动力学监测受到内脏大循环与微循环之间差异的阻碍。脉搏轮廓分析（PiCCO）为评估危重症患者的容量状态提供了新参数。然而，区域循环的变化，尤其是影响内脏灌注的变化，已被证明尤为重要。我们研究的目的是比较多器官功能衰竭的严重脓毒症患者的大循环血流动力学参数（PiCCO）与微循环（OPS成像）。
对7例脓毒性休克和多器官功能衰竭患者（急性生理与慢性健康状况评分系统II评分>25）每隔24小时进行一次PiCCO监测和OPS成像重复检查。在6个不同的颊部和舌下部位记录20秒的OPS数据，充分反映肝脏和小肠的微血管灌注。数据被录像以供离线分析，计算小静脉和大静脉（<25微米和>25微米）中的血流速度以及功能性毛细血管密度。
小静脉血流速度与全身血管阻力（r² = 0.252，p < 0.05）、平均动脉血压（r² = 0.259，p < 0.05）和pH值（r² = 0.265，p < 0.05）之间存在显著相关性。此外，氧输送指数与小血管密度之间存在显著相关性（r² = 0.355；p < 0.05）。
根据我们的研究结果，通过PiCCO监测获得的数据可用于粗略估计严重脓毒症和多器官功能衰竭期间的微循环。然而，对于评估局部灌注情况，我们研究的参数在使用上存在局限性。对于非侵入性可及且代表内脏灌注的部位进行测量时，OPS是更准确的微循环特征化方法，尽管需要更广泛且耗时的分析。
