Division of Pulmonary, Critical Care, and Sleep Medicine, Bellevue Hospital Center, New York University School of Medicine, New York, New York, USA.
Curr Opin Crit Care. 2017 Jun;23(3):232-236. doi: 10.1097/MCC.0000000000000403.
Monitoring of mental status and peripheral circulatory changes can be accomplished noninvasively in patients in the ICU. Emphasis on physical examination in conditions such as sepsis have gained increased attention as these evaluations can often serve as a surrogate marker for short-term treatment efficacy of therapeutic interventions. Sepsis associated encephalopathy and mental status changes correlate with worse prognosis in patients. Evaluation of peripheral circulation has been shown to be a convenient, easily accessible, and accurate marker for prognosis in patients with septic shock. The purpose of this article is to emphasize the main findings according to recent literature into the monitoring of physical examination changes in patients with sepsis.
Several recent studies have expanded our knowledge about the pathophysiology of mental status changes and the clinical assessment of peripheral circulation in patients with sepsis. Sepsis-associated encephalopathy is associated with an increased rate of morbidity and mortality in an intensive care setting. Increased capillary refill time (CRT) and persistent skin mottling are strongly predictive of mortality, whereas temperature gradients can reveal vasoconstriction and more severe organ dysfunction.
Monitoring of physical examination changes is a significant and critical intervention in patients with sepsis. Utilizing repeated neurologic evaluations, and assessing CRT, mottling score, and skin temperature gradients should be emphasized as important noninvasive diagnostic tools. The significance of these methods can be incorporated during the utilization of therapeutic strategies in resuscitation protocols in patients with sepsis.
在重症监护病房（ICU）的患者中，可以通过非侵入性方法监测精神状态和外周循环变化。在脓毒症等情况下，强调体格检查的重要性已得到越来越多的关注，因为这些评估通常可以作为治疗干预短期疗效的替代标志物。脓毒症相关脑病和精神状态改变与患者的预后较差相关。已经证明，评估外周循环是预测脓毒性休克患者预后的一种方便、易于获得且准确的标志物。本文的目的是根据最近的文献强调监测脓毒症患者体格检查变化的主要发现。
几项最近的研究扩展了我们对脓毒症患者精神状态改变和外周循环临床评估的病理生理学的认识。脓毒症相关脑病与 ICU 中的发病率和死亡率增加有关。毛细血管再充盈时间（CRT）增加和持续皮肤斑点强烈预测死亡率，而温度梯度可揭示血管收缩和更严重的器官功能障碍。
监测体格检查变化是脓毒症患者的一项重要且关键的干预措施。重复进行神经评估，并评估 CRT、斑点评分和皮肤温度梯度，应作为重要的非侵入性诊断工具加以强调。这些方法的意义可以在脓毒症患者的复苏方案中治疗策略的应用中得到体现。
