脓毒症患者的眼部微血管变化：一项前瞻性观察研究。
Ocular microvascular changes in patients with sepsis: a prospective observational study.
作者信息
Simkiene Jurate, Pranskuniene Zivile, Vitkauskiene Astra, Pilvinis Vidas, Boerma E Christiaan, Pranskunas Andrius
机构信息
Department of Intensive Care Medicine, Lithuanian University of Health Sciences, Eiveniu str. 2, Kaunas, 50009, Lithuania.
Department of Drug Technology and Social Pharmacy, Lithuanian University of Health Sciences, Eiveniu str. 2, Kaunas, 50009, Lithuania.
出版信息
Ann Intensive Care. 2020 Apr 7;10(1):38. doi: 10.1186/s13613-020-00655-x.
BACKGROUND
The aim of the study was to detect differences in the conjunctival microcirculation between septic patients and healthy subjects and to evaluate the course of conjunctival and retinal microvasculature in survivors and non-survivors over a 24-h period of time.
METHODS
This single-center prospective observational study was performed in mixed ICU in a tertiary teaching hospital. We included patients with sepsis or septic shock within the first 24 h after ICU admission. Conjunctival imaging, using an IDF video microscope, and retinal imaging, using portable digital fundus camera, as well as systemic hemodynamic measurements, were performed at three time points: at baseline, 6 h and 24 h. Baseline conjunctival microcirculatory parameters were compared with healthy controls.
RESULTS
A total of 48 patients were included in the final assessment and analysis. Median APACHE II and SOFA scores were 16[12-21] and 10[7-12], respectively. Forty-four (92%) patients were in septic shock, 48 (100%) required mechanical ventilation. 19 (40%) patients were discharged alive from the intensive care unit. We found significant reductions in all microcirculatory parameters in the conjunctiva when comparing septic and healthy subjects. In addition, we observed a significant lower microvascular flow index (MFI) of small conjunctival vessels during all three time points in non-survivors compared with survivors. However, retinal arteriolar vessels were not different between survivors and non-survivors.
CONCLUSIONS
Conjunctival microvascular blood flow was altered in septic patients. In the 24-h observation period conjunctival small vessels had a significantly higher MFI, but no difference in retinal arteriolar diameter in survivors in comparison with non-survivors. Trial registration NCT04214743, https://www.clinicaltrials.gov. Date of registration: 31 December 2019 - Retrospectively registered, https://clinicaltrials.gov/ct2/show/NCT04214743.
背景
本研究的目的是检测脓毒症患者与健康受试者结膜微循环的差异，并评估存活者和非存活者在24小时内结膜和视网膜微血管系统的变化过程。
方法
本单中心前瞻性观察研究在一家三级教学医院的混合重症监护病房进行。我们纳入了入住重症监护病房后24小时内患有脓毒症或脓毒性休克的患者。使用IDF视频显微镜进行结膜成像，使用便携式数字眼底相机进行视网膜成像，并在三个时间点进行全身血流动力学测量：基线、6小时和24小时。将基线结膜微循环参数与健康对照进行比较。
结果
共有48例患者纳入最终评估和分析。急性生理与慢性健康状况评分系统（APACHE II）和序贯器官衰竭评估（SOFA）评分的中位数分别为16[12 - 21]和10[7 - 12]。44例（92%）患者处于脓毒性休克，48例（100%）需要机械通气。19例（40%）患者从重症监护病房存活出院。我们发现，与健康受试者相比，脓毒症患者结膜的所有微循环参数均显著降低。此外，我们观察到，在所有三个时间点，非存活者结膜小血管的微血管血流指数（MFI）均显著低于存活者。然而，存活者和非存活者的视网膜小动脉血管并无差异。
结论
脓毒症患者结膜微血管血流发生改变。在24小时观察期内，与非存活者相比，存活者结膜小血管的MFI显著更高，但视网膜小动脉直径无差异。试验注册号NCT04214743，https://www.clinicaltrials.gov。注册日期：2019年12月31日 - 追溯注册，https://clinicaltrials.gov/ct2/show/NCT04214743。
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