舌下微循环、组织灌注与重大创伤后器官衰竭的关系：一项前瞻性观察研究的亚组分析。
Association between sublingual microcirculation, tissue perfusion and organ failure in major trauma: A subgroup analysis of a prospective observational study.
机构信息
Anaesthesia and Intensive Care, Department of Biomedical Sciences and Public Health, Università Politecnica delle Marche, Ancona, Italy.
出版信息
PLoS One. 2019 Mar 5;14(3):e0213085. doi: 10.1371/journal.pone.0213085. eCollection 2019.
INTRODUCTION
Previous studies described impaired microvascular perfusion and tissue oxygenation as reliable predictors of Multiple Organ Failure in major trauma. However, this relationship has been incompletely investigated. The objective of this analysis is to further evaluate the association between organ dysfunction and microcirculation after trauma.
MATERIALS AND METHODS
This is a retrospective subgroup analysis on 28 trauma patients enrolled for the Microcirculation DAIly MONitoring in critically ill patients study (NCT 02649088). Patients were divided in two groups according with their Sequential Organ Failure Assessment (SOFA) score at day 4. At admission and every 24 hours, the sublingual microcirculation was evaluated with Sidestream Darkfield Imaging (SDF) and peripheral tissue perfusion was assessed with Near Infrared Spectroscopy (NIRS) and Vascular Occlusion Test (VOT). Simultaneously, hemodynamic, clinical/laboratory parameters and main organ supports were collected.
RESULTS
Median SOFA score at Day 4 was 6.5. Accordingly, patients were divided in two groups: D4-SOFA ≤6.5 and D4-SOFA >6.5. The Length of Stay in Intensive Care was significantly higher in patients with D4-SOFA>6.5 compared to D4-SOFA≤6.5 (p = 0.013). Total Vessel Density of small vessels was significantly lower in patients with high D4-SOFA score at Day 1 (p = 0.002) and Day 2 (p = 0.006) after admission; the Perfused Vessel Density was lower in patients with high D4-SOFA score at Day 1 (p = 0.007) and Day 2 (p = 0.033). At Day 1, NIRS monitoring with VOT showed significantly faster tissue oxygen saturation downslope (p = 0.018) and slower upslope (p = 0.04) in patients with high D4-SOFA.
DISCUSSION
In our cohort of major traumas, sublingual microcirculation and peripheral microvascular reactivity were significantly more impaired early after trauma in those patients who developed more severe organ dysfunctions. Our data would support the hypothesis that restoration of macrocirculation can be dissociated from restoration of peripheral and tissue perfusion, and that microvascular alterations can be associated with organ failure.
简介
既往研究表明，微血管灌注和组织氧合受损可作为多发伤患者多器官功能衰竭的可靠预测指标。然而，这种关系尚未得到充分研究。本分析的目的是进一步评估创伤后器官功能障碍与微循环之间的关系。
材料和方法
这是一项对 28 名创伤患者的回顾性亚组分析，这些患者参与了危重患者的微循环日常监测研究（NCT 02649088）。根据第 4 天的序贯器官衰竭评估（SOFA）评分，患者分为两组。入院时和每 24 小时，采用 Sidestream Darkfield Imaging（SDF）评估舌下微循环，采用近红外光谱（NIRS）和血管闭塞试验（VOT）评估外周组织灌注。同时收集血流动力学、临床/实验室参数和主要器官支持情况。
结果
第 4 天的中位 SOFA 评分为 6.5。因此，患者分为两组：D4-SOFA≤6.5 和 D4-SOFA>6.5。D4-SOFA>6.5 的患者 ICU 住院时间明显长于 D4-SOFA≤6.5 的患者（p=0.013）。入院第 1 天（p=0.002）和第 2 天（p=0.006）高 D4-SOFA 评分患者的小血管总血管密度明显降低；入院第 1 天（p=0.007）和第 2 天（p=0.033）高 D4-SOFA 评分患者的灌注血管密度降低。入院第 1 天，VOT 监测的 NIRS 显示，D4-SOFA 较高的患者组织氧饱和度下降斜率明显更快（p=0.018），上升斜率较慢（p=0.04）。
讨论
在我们的大型创伤患者队列中，那些发生更严重器官功能障碍的患者在创伤后早期舌下微循环和外周微血管反应性明显受损。我们的数据支持这样一种假设，即微循环的恢复可以与外周和组织灌注的恢复分离，微血管改变可能与器官衰竭有关。
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