Wang Cui, Wang Xiaoting, Zhang Hongmin, Su Longxiang, Huang Wei, Liu Dawei
Department of Critical Care Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Shock. 2020 Dec;54(6):723-730. doi: 10.1097/SHK.0000000000001547.
Peripheral vascular disorders leading to tissue hypoperfusion play a central role in the pathophysiology of organ failure in septic shock. The Doppler snuffbox resistive index (SBRI) can be an accurate parameter to evaluate the status of peripheral vasculature at the bedside. We evaluated whether the SBRI is related to lactate levels or the peripheral perfusion index (PI) and its ability to predict lactate clearance in septic patients.
We conducted a prospective observational study in a tertiary general and teaching hospital in China. From July 2019 to December 2019, all consecutive adult patients with septic shock who required intensive care unit admission were included. At the same time, 20 stable postoperative patients were studied as a control group. We recorded the hemodynamic parameters, including the SBRI and PI, which were measured simultaneously after patient recruitment.
We evaluated 44 patients with septic shock in the study group and 20 stable postoperative patients in the control group. Patients with septic shock had higher Sequential Organ Failure Assessment scores, procalcitonin levels, cardiac index (CI) and lactate levels than patients in the control group. The SBRI was correlated with the PI and lactate level. The CI was not correlated with lactate level in the patients examined. Based on lactate clearance in the first 6 h, the septic shock patients were divided into two groups: one with lactate clearance ≥20% (n = 28) and the other with lactate clearance <20% (n = 16). The CI was not significantly different between the two groups. The SBRI of the lactate clearance <20% group was higher than that of the lactate clearance ≥20% group and the control group. The PI of the lactate clearance <20% group was lower than that of the lactate clearance ≥20% group and the control group. The SBRI cutoff value for predicting 6-h lactate clearance after resuscitation was ≥1.09, with a sensitivity of 68.8% and a specificity of 85.7%. The PI cutoff value for predicting 6-h lactate clearance after resuscitation was ≤0.99, with a sensitivity of 64.3% and a specificity of 81.2%. The SBRI was significantly better than the PI for predicting 6-h lactate clearance after resuscitation (area under the curve: 0.805 vs. 0.703, P < 0.05).
The Doppler SBRI is correlated with tissue perfusion parameters in critically ill patients. An abnormal SBRI may be better than the PI for predicting poor lactate clearance in septic patients. Further investigations are required to determine whether correcting an abnormal SBRI and PI may improve the success rate of septic shock resuscitation.
导致组织灌注不足的外周血管疾病在脓毒症休克器官衰竭的病理生理过程中起核心作用。多普勒鼻烟窝阻力指数（SBRI）可能是一种在床边评估外周血管系统状态的准确参数。我们评估了SBRI是否与乳酸水平或外周灌注指数（PI）相关，以及其预测脓毒症患者乳酸清除率的能力。
我们在中国一家三级综合教学医院进行了一项前瞻性观察研究。2019年7月至2019年12月，纳入所有连续入住重症监护病房的成年脓毒症休克患者。同时，选取20例术后病情稳定的患者作为对照组。我们记录了血流动力学参数，包括SBRI和PI，在纳入患者后同时进行测量。
我们研究组评估了44例脓毒症休克患者，对照组评估了20例术后病情稳定的患者。脓毒症休克患者的序贯器官衰竭评估评分、降钙素原水平、心脏指数（CI）和乳酸水平均高于对照组患者。SBRI与PI和乳酸水平相关。在所检查的患者中，CI与乳酸水平不相关。根据复苏后最初6小时的乳酸清除率，脓毒症休克患者分为两组：一组乳酸清除率≥20%（n = 28），另一组乳酸清除率<20%（n = 16）。两组间CI无显著差异。乳酸清除率<20%组的SBRI高于乳酸清除率≥20%组和对照组。乳酸清除率<20%组的PI低于乳酸清除率≥20%组和对照组。复苏后预测6小时乳酸清除率的SBRI临界值≥1.09，敏感性为68.8%，特异性为85.7%。复苏后预测6小时乳酸清除率的PI临界值≤0.99，敏感性为64.3%，特异性为81.2%。在预测复苏后6小时乳酸清除率方面，SBRI显著优于PI（曲线下面积：0.805对0.703，P < 0.05）。
多普勒SBRI与危重症患者的组织灌注参数相关。异常的SBRI在预测脓毒症患者乳酸清除不佳方面可能优于PI。需要进一步研究以确定纠正异常的SBRI和PI是否可提高脓毒症休克复苏的成功率。
