Edul Vanina Siham Kanoore, Ince Can, Navarro Noelia, Previgliano Luciana, Risso-Vazquez Alejandro, Rubatto Paolo Nahuel, Dubin Arnaldo
Academic Medical Center, Department of Translational Physiology, Amsterdam, Netherlands ; Facultad de Ciencias Médicas, Universidad Nacional de La Plata, Cátedra de Farmacología Aplicada, Calle 42 N° 577 (1900), La Plata, Argentina.
Academic Medical Center, Department of Translational Physiology, Amsterdam, Netherlands.
Ann Intensive Care. 2014 Dec 4;4:39. doi: 10.1186/s13613-014-0039-3. eCollection 2014.
This study was performed to compare intestinal and sublingual microcirculation and their response to a fluid challenge.
Twenty-two septic patients in the first postoperative day of an intestinal surgery, in which an ostomy had been constructed, were evaluated both before and 20 min after a challenge of 10 mL/kg of 6% hydroxyethylstarch 130/0.4. We measured systemic hemodynamics and sublingual and intestinal microcirculation. Correlations between variables were determined through the Pearson test.
Fluid administration increased the cardiac index (2.6 ± 0.5 vs. 3.3 ± 1.0 L/min/m(2), P < 0.01) and mean arterial blood pressure (68 ± 11 vs. 82 ± 12 mm Hg, P < 0.0001). The sublingual but not the intestinal red blood cell (RBC) velocity increased (912 ± 270 vs. 1,064 ± 200 μm/s, P < 0.002 and 679 ± 379 vs. 747 ± 419 μm/s, P = 0.12, respectively). The sublingual and intestinal perfused vascular density (PVD) did not change significantly (15.2 ± 2.9 vs. 16.1 ± 1.2 mm/mm(2) and 12.3 ± 6.7 vs. 13.0 ± 6.7 mm/mm(2)). We found no correlation between the basal sublingual and intestinal RBC velocities or between their changes in response to the fluid challenge. The individual changes in sublingual RBC velocity correlated with those in cardiac index and basal RBC velocity. Individual changes in intestinal RBC velocity did not correlate with either the cardiac index modifications or the basal RBC velocity. The same pattern was observed with the sublingual and the intestinal PVDs. The sublingual RBC velocities and PVDs were similar between survivors and nonsurvivors. But the intestinal RBC velocities and PVDs were lower in nonsurvivors.
In this series of postoperative septic patients, we found a dissociation between sublingual and intestinal microcirculation. The improvement in the sublingual microcirculation after fluid challenge was dependent on the basal state and the increase in cardiac output. In contrast, the intestinal microcirculation behaved as an isolated territory.
本研究旨在比较肠道和舌下微循环及其对液体冲击的反应。
对22例在肠道手术后第一天且已行造口术的脓毒症患者，在给予10 mL/kg的6%羟乙基淀粉130/0.4冲击前及冲击后20分钟进行评估。我们测量了全身血流动力学以及舌下和肠道微循环。通过Pearson检验确定变量之间的相关性。
液体输注使心脏指数增加（2.6±0.5对3.3±1.0 L/min/m²，P<0.01）以及平均动脉血压升高（68±11对82±12 mmHg，P<0.0001）。舌下红细胞（RBC）速度增加，而肠道RBC速度未增加（分别为912±270对1,064±200 μm/s，P<0.002和679±379对747±419 μm/s，P=0.12）。舌下和肠道灌注血管密度（PVD）无显著变化（15.2±2.9对16.1±1.2 mm/mm²和12.3±6.7对13.0±6.7 mm/mm²）。我们发现基础舌下和肠道RBC速度之间或它们对液体冲击反应的变化之间无相关性。舌下RBC速度的个体变化与心脏指数和基础RBC速度的变化相关。肠道RBC速度的个体变化与心脏指数变化或基础RBC速度均无相关性。舌下和肠道PVDs也观察到相同模式。存活者和非存活者之间舌下RBC速度和PVDs相似。但非存活者的肠道RBC速度和PVDs较低。
在这组术后脓毒症患者中，我们发现舌下和肠道微循环之间存在分离。液体冲击后舌下微循环的改善取决于基础状态和心输出量的增加。相比之下，肠道微循环表现为一个独立区域。
