液体冲击后毛细血管再充盈时间的动力学

Kinetics of capillary refill time after fluid challenge.

作者信息

Raia Lisa, Gabarre Paul, Bonny Vincent, Urbina Tomas, Missri Louai, Boelle Pierre-Yves, Baudel Jean-Luc, Guidet Bertrand, Maury Eric, Joffre Jeremie, Ait-Oufella Hafid

机构信息

Service de Médecine Intensive-Réanimation, Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Antoine, 184 rue du Faubourg Saint-Antoine, 75571, Paris cedex 12, France.

Sorbonne Université, Paris, France.

出版信息

Ann Intensive Care. 2022 Aug 13;12(1):74. doi: 10.1186/s13613-022-01049-x.

DOI:10.1186/s13613-022-01049-x

PMID:35962860

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9375797/

Abstract

BACKGROUND

Capillary refill time (CRT) is a valuable tool for triage and to guide resuscitation. However, little is known about CRT kinetics after fluid infusion.

METHODS

We conducted a prospective observational study in a tertiary teaching hospital. First, we analyzed the intra-observer variability of CRT. Next, we monitored fingertip CRT in sepsis patients during volume expansion within the first 24 h of ICU admission. Fingertip CRT was measured every 2 min during 30 min following crystalloid infusion (500 mL over 15 min).

RESULTS

First, the accuracy of repetitive fingertip CRT measurements was evaluated on 40 critically ill patients. Reproducibility was excellent, with an intra-class correlation coefficient of 99.5% (CI 95% [99.3, 99.8]). A CRT variation larger than 0.2 s was considered as significant. Next, variations of CRT during volume expansion were evaluated on 29 septic patients; median SOFA score was 7 [5-9], median SAPS II was 57 [45-72], and ICU mortality rate was 24%. Twenty-three patients were responders as defined by a CRT decrease > 0.2 s at 30 min after volume expansion, and 6 were non-responders. Among responders, we observed that fingertip CRT quickly improved with a significant decrease at 6-8 min after start of crystalloid infusion, the maximal improvement being observed after 10-12 min (-0.7 [-0.3;-0.9] s) and maintained at 30 min. CRT variations significantly correlated with baseline CRT measurements (R = 0.39, P = 0.05).

CONCLUSIONS

CRT quickly improved during volume expansion with a significant decrease 6-8 min after start of fluid infusion and a maximal drop at 10-12 min.

摘要

背景

毛细血管再充盈时间（CRT）是分诊和指导复苏的一项重要指标。然而，关于液体输注后CRT的动力学变化，人们了解甚少。

方法

我们在一家三级教学医院开展了一项前瞻性观察性研究。首先，我们分析了CRT测量的观察者内变异性。接下来，我们在脓毒症患者入住重症监护病房（ICU）的头24小时内进行容量复苏时监测指尖CRT。在晶体液输注（15分钟内输注500毫升）后的30分钟内，每隔2分钟测量一次指尖CRT。

结果

首先，我们对40例危重症患者进行了重复性指尖CRT测量的准确性评估。测量的可重复性极佳，组内相关系数为99.5%（95%置信区间[99.3, 99.8]）。CRT变化大于0.2秒被视为有显著意义。接下来，我们对29例脓毒症患者容量复苏期间的CRT变化进行了评估；序贯器官衰竭评估（SOFA）评分中位数为7[5 - 9]，简化急性生理学评分（SAPS）II中位数为57[45 - 72]，ICU死亡率为24%。根据容量复苏后30分钟时CRT下降>0.2秒的定义，23例患者为反应者，6例为无反应者。在反应者中，我们观察到指尖CRT在晶体液输注开始后6 - 8分钟时迅速改善且显著下降，在10 - 12分钟时改善最大（-0.7[-0.3; -0.9]秒）并维持至30分钟。CRT变化与基线CRT测量值显著相关（R = 0.39，P = 0.05）。