School of Veterinary Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
J Vet Emerg Crit Care (San Antonio). 2020 Nov;30(6):670-676. doi: 10.1111/vec.12992. Epub 2020 Sep 23.
To evaluate the difference in the rectal-interdigital temperature gradient (RITG) between dogs that were presented to an emergency room with clinical signs of shock compared to those without signs of shock, and if this gradient can be used as a diagnostic marker for shock.
Prospective, single center, observational study conducted from 2014 to 2015.
University veterinary teaching hospital.
Twenty dogs with a clinical diagnosis of shock and 60 dogs without a clinical diagnosis of shock (controls).
Upon presentation to the emergency room and prior to intervention, measurements of rectal temperature, interdigital temperature, ambient temperature, systemic markers of perfusion (capillary refill time [CRT], heart rate [HR], respiratory rate [RR], Doppler blood pressure [DBP], and venous plasma lactate concentration), and venous blood gas analytes were recorded. Dogs were initially determined to be in shock by the attending clinician, and post hoc inclusion criteria were applied. Shock was defined as abnormalities in ≥3 of the 6 following criteria: HR > 120/min, RR > 40/min, CRT > 2 seconds, rectal temperature <37.8°C (100.0°F), venous plasma lactate concentration >2.5 mmol/L, or DBP < 90 mm Hg. Animals with circulatory shock had a significantly increased RITG. An increased RITG was also correlated with individual perfusion parameters including prolonged CRT (ρ = .353, P = 0.0013), tachycardia (ρ = .3485, P = 0.0015), decreased DBP (ρ = -0.6162, P = 0.0003), and shock index (ρ = 0.6168, P = 0.0003). Receiver operator curve analysis indicated a RITG cutoff point of 11.6°F had 90% specificity for the diagnosis of shock (area under the curve = 0.7604).
The RITG in this study was associated with a diagnosis of shock and therefore may serve as a diagnostic marker of circulatory shock. Future studies with larger sample sizes to validate the use of temperature gradients and other peripheral perfusion abnormalities as diagnostic and monitoring tools are warranted.
评估出现休克临床症状的犬与无休克临床症状的犬之间直肠-指（趾）温差（RITG）的差异，以及该梯度是否可作为休克的诊断标志物。
2014 年至 2015 年进行的前瞻性、单中心、观察性研究。
大学兽医教学医院。
20 只临床诊断为休克的犬和 60 只无临床诊断为休克的犬（对照组）。
在急诊室就诊时，在进行干预之前，记录直肠温度、指（趾）间温度、环境温度、灌注的全身标志物（毛细血管再充盈时间 [CRT]、心率 [HR]、呼吸频率 [RR]、多普勒血压 [DBP] 和静脉血乳酸浓度）以及静脉血气分析值。最初由主治临床医生确定犬患有休克，然后应用事后纳入标准。休克定义为以下 6 个标准中的≥3 个出现异常：HR>120/min、RR>40/min、CRT>2 秒、直肠温度<37.8°C（100.0°F）、静脉血乳酸浓度>2.5mmol/L 或 DBP<90mmHg。患有循环性休克的动物的 RITG 明显增加。增加的 RITG 还与个体灌注参数相关，包括 CRT 延长（ρ=0.353，P=0.0013）、心动过速（ρ=0.3485，P=0.0015）、DBP 降低（ρ=-0.6162，P=0.0003）和休克指数（ρ=0.6168，P=0.0003）。受试者工作特征曲线分析表明，RITG 截断点为 11.6°F 时，对休克的诊断具有 90%的特异性（曲线下面积=0.7604）。
本研究中的 RITG 与休克诊断相关，因此可能是循环性休克的诊断标志物。需要进一步开展更大样本量的研究，以验证温度梯度和其他外周灌注异常作为诊断和监测工具的用途。
