Zhou Yuankai, He Huaiwu, Wang Xiaoting, Cui Na, Zhou Xiang, Long Yun, Liu Dawei
State Key Laboratory of Complex Severe and Rare Diseases, Department of Critical Care Medicine, Peking Union Medical College, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China.
Front Med (Lausanne). 2021 Nov 24;8:762376. doi: 10.3389/fmed.2021.762376. eCollection 2021.
This study aimed to measure blood flow changes in the superior mesenteric artery (SMA), using Doppler ultrasound, in post-cardiac surgery patients, to evaluate the correlation between the SMA resistance index (SMA-RI) and lactate concentrations. The patients' basic hemodynamics, blood gas parameters and lactate concentration were collected at admission. Simultaneously, the SMA blood flow parameters were collected using Doppler ultrasound with the patients in the supine position. The lactate concentrations were measured again at 2, 6, and 12-h time points after the first test. The length of intensive care unit stays and prognoses continued to be monitored. A total of 67 patients were included. The SMA-RI correlated with the admission ( = 0.3117, = 0.0102), 2-h ( = 0.5091, < 0.0001), 6-h ( = 0.5061, < 0.0001), and 12-h ( = 0.2483, = 0.0428) lactate concentrations. The SMA-RI could predict the 2-h 10% [area under the curve (AUC) = 0.8294, < 0.0001] and 6-h 40% lactate kinetics (AUC = 0.7708, = 0.0012). The cut-off value was 0.83. When the SMA-RI was <0.83, the specificity and sensitivity were 86.38 and 75.56%, respectively for the prediction of the 2-h >10% lactate kinetics, and 64.71 and 75.00%, respectively, for the prediction of the 6-h >40% lactate kinetics. The lactate concentrations at admission, 2 and 6-h points were higher in the high-RI group (RI ≥ 0.83) and the intensive care unit stays were significantly longer than in the low-RI group ( = 0.0005). The increase in SMA-RI was associated with higher lactate concentrations and worse lactate kinetics in post-cardiac surgery patients. This may be related to intestinal hypoperfusion. The SMA-RI may be one of the indicators that should be monitored to guide resuscitation in these patients.
本研究旨在利用多普勒超声测量心脏手术后患者肠系膜上动脉（SMA）的血流变化，以评估SMA阻力指数（SMA-RI）与乳酸浓度之间的相关性。在患者入院时收集其基本血流动力学、血气参数和乳酸浓度。同时，让患者仰卧位，使用多普勒超声收集SMA血流参数。在首次检测后的2小时、6小时和12小时时间点再次测量乳酸浓度。持续监测重症监护病房的住院时间和预后情况。共纳入67例患者。SMA-RI与入院时（r = 0.3117，P = 0.0102）、2小时（r = 0.5091，P < 0.0001）、6小时（r = 0.5061，P < 0.0001）和12小时（r = 0.2483，P = 0.0428）的乳酸浓度相关。SMA-RI能够预测2小时10%[曲线下面积（AUC）= 0.8294，P < 0.0001]和6小时40%的乳酸动力学变化（AUC = 0.7708，P = 0.0012）。截断值为0.83。当SMA-RI < 0.83时，预测2小时乳酸动力学变化> 10%的特异性和敏感性分别为86.38%和75.56%，预测6小时乳酸动力学变化> 40%的特异性和敏感性分别为64.71%和75.00%。高阻力指数组（RI≥0.83）入院时、2小时和6小时的乳酸浓度较高，且重症监护病房的住院时间显著长于低阻力指数组（P = 0.0005）。心脏手术后患者SMA-RI的升高与较高的乳酸浓度和较差的乳酸动力学变化相关。这可能与肠道灌注不足有关。SMA-RI可能是这些患者复苏过程中应监测的指标之一。
