Intensive Care, Erasmus Medical Center-Sophia Children's Hospital, Rotterdam, The Netherlands.
Crit Care Med. 2011 Jan;39(1):8-13. doi: 10.1097/CCM.0b013e3181fb7994.
To investigate the time course and predictive value of microvascular alterations in children with severe sepsis.
Single-center, prospective observational study.
Intensive care unit of a level III university children's hospital.
Patients with septic shock, requiring the administration of fluid and vasopressor agents and/or inotropes after the correction of hypovolemia, who were intubated and ventilated, were included.
None.
The microcirculation was assessed in the buccal mucosa, using orthogonal polarization spectral imaging, within 24 hrs after admission. Subsequent measurements were performed every 24 hrs for 3 days. The measurements were discontinued when the patient was extubated. There were no significant differences in the functional capillary density or microvascular flow index for all vessel types between survivors and nonsurvivors on day 1. In the survival group, the functional capillary density increased significantly between day 1 and day 2 from 1.7 cm/cm (0.8-3.4) to 4.3 cm/cm (2.1-6.9) (p = .001). Functional capillary density values in nonsurvivors did not change (day 1: 3.2 cm/cm [0.8-3.8]; day 2: 1.9 cm/cm [1.0-2.1]). The median functional capillary density on days 2 and 3 were significantly lower in nonsurvivors (day 2: 1.9 cm/cm [1.0 -2.1] vs. 4.3 cm/cm [2.1-6.9], p = .009; day 3: 1.8 cm/cm [1.0-2.0] vs. 4.7 cm/cm [2.1-8.6], p = .01). The microvascular flow index for all vessel types improved in survivors and did not change in nonsurvivors. Differences in microvascular flow index values between survivors and nonsurvivors were not significant.
Persistent microcirculatory alterations can be prognostic for survival in children with septic shock.
探讨严重脓毒症患儿微血管改变的时间过程和预测价值。
单中心前瞻性观察性研究。
三级大学儿童医院的重症监护病房。
纳入标准为脓毒性休克患者，在纠正低血容量后需要给予液体和血管加压药和/或正性肌力药，并需要插管和通气。
无。
在入院后 24 小时内，使用正交偏振光谱成像技术评估颊黏膜的微循环。随后每 24 小时测量 3 天。当患者拔管时停止测量。第 1 天，存活组和非存活组之间所有血管类型的功能性毛细血管密度或微血管血流指数均无显著差异。在存活组，功能性毛细血管密度从第 1 天的 1.7 cm/cm（0.8-3.4）到第 2 天的 4.3 cm/cm（2.1-6.9）显著增加（p=0.001）。非存活组的功能性毛细血管密度值没有变化（第 1 天：3.2 cm/cm[0.8-3.8]；第 2 天：1.9 cm/cm[1.0-2.1]）。第 2 天和第 3 天非存活组的功能性毛细血管密度中位数明显较低（第 2 天：1.9 cm/cm[1.0-2.1] vs. 4.3 cm/cm[2.1-6.9]，p=0.009；第 3 天：1.8 cm/cm[1.0-2.0] vs. 4.7 cm/cm[2.1-8.6]，p=0.01）。所有血管类型的微血管血流指数在存活组中均有所改善，而非存活组则无变化。存活组和非存活组之间的微血管血流指数值差异无统计学意义。
持续的微血管改变可能是儿童脓毒性休克患者生存的预后因素。
